Large Colon Information Inflammatory bowel disease (IBD) Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn’s disease. IBD can be painful and debilitating, and sometimes leads to life-threatening complications. Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease that causes longlasting inflammation in part of your digestive tract. Symptoms usually develop over time, rather than suddenly. Ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. It occurs only through continuous stretches of your colon. Crohn’s disease is an inflammatory bowel disease that causes inflammation anywhere along the lining of your digestive tract, and often spreads deep into affected tissues. This can lead to abdominal pain, severe diarrhea and even malnutrition. The inflammation caused by Crohn’s disease can involve different areas of the digestive tract in different people. Collagenous colitis (kuh-LAJ-uh-nus) and lymphocytic colitis also are considered inflammatory bowel diseases, but are usually regarded separately from classic inflammatory bowel disease.

What are the symptoms of Inflammatory bowel disease? (IBD) Inflammatory bowel disease symptoms vary, depending on the severity of inflammation and where it occurs.

Ulcerative colitis symptoms Ulcerative colitis is classified according to its signs and symptoms: ■

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Ulcerative proctitis. In this form of ulcerative colitis, inflammation is confined to the area closest to the anus (rectum), and for some people, rectal bleeding may be the only sign of the disease. Others may have rectal pain, a feeling of urgency or have frequent, small bowel movements. This form of ulcerative colitis tends to be the mildest. Proctosigmoiditis. This form involves the rectum and the lower end of the colon, known as the sigmoid colon. Bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus) are common problems associated with this form of the disease. Left-sided colitis. As the name suggests, inflammation extends from the rectum up through the sigmoid and descending colon, which are located in the upper left part of the abdomen. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss. Pancolitis. Affecting more than the left colon and often the entire colon, pancolitis causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.

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Fulminant colitis. This rare, life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhea and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications, including colon rupture and toxic megacolon, a condition that causes the colon to rapidly expand.

The course of ulcerative colitis varies, with periods of acute illness often alternating with periods of remission. Most people with a milder condition, such as ulcerative proctitis, won’t go on to develop more-severe signs and symptoms.

Crohn’s disease symptoms Inflammation of Crohn’s disease may involve different parts of the digestive tract in different people. The most common areas affected by Crohn’s disease are the last part of the small intestine called the ileum and the colon. Inflammation may be confined to the bowel wall, which can lead to scarring (stenosis), or inflammation may spread through the bowel wall (fistula). Signs and symptoms of Crohn’s disease can range from mild to severe and may develop gradually or come on suddenly, without warning. Signs and symptoms may include: ■

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Diarrhea. The inflammation that occurs in Crohn’s disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can’t completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. Diarrhea is a common problem for people with Crohn’s. Abdominal pain and cramping. Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of contents through your digestive tract and may lead to pain and cramping. Mild Crohn’s disease usually causes slight to moderate intestinal discomfort, but in more-serious cases, the pain may be severe and include nausea and vomiting. Blood in your stool. Food moving through your digestive tract may cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don’t see (occult blood). Ulcers. Crohn’s disease and ulcerative colitis can cause small sores on the surface of the intestine that eventually become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You may also have ulcers elsewhere, including in your mouth similar to canker sores. Reduced appetite and weight loss. Abdominal pain and cramping and inflammation of your bowel wall can affect both your appetite and your ability to digest and absorb food.

People with severe Crohn’s disease may also experience: ■

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Fever Fatigue Arthritis Eye inflammation Skin disorders Inflammation of the liver or bile ducts Delayed growth or sexual development, in children

When to see a doctor See your doctor if you experience a persistent change in your bowel habits or if you have any of the signs and symptoms of inflammatory bowel disease. Although inflammatory bowel disease usually isn’t fatal, it’s a serious disease that, in some cases, may cause life-threatening complications.

What are the causes of Inflammatory bowel disease? (IBD) No one is quite sure what triggers inflammatory bowel disease, but there’s a consensus as to what doesn’t. Researchers no longer believe that diet and stress are main causes, although stress can often aggravate symptoms. Instead, current thinking focuses on the: ■

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Immune system. Some scientists think a virus or bacterium may trigger IBD. The digestive tract becomes inflamed when your immune system tries to fight off the invading microorganism (pathogen). It’s also possible that inflammation may stem from an autoimmune reaction in which your body mounts an immune response even though no pathogen is present. Heredity. Because you’re more likely to develop IBD if you have a parent or sibling with the disease, scientists suspect that genetic makeup may play a role. However, most people who have IBD don’t have a family history of the disorder.

What is the risk factor? Inflammatory bowel disease affects about the same number of women and men. Risk factors may include: ■

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Age. Inflammatory bowel disease usually begins before the age of 30. But, it can occur at any age, and some people may not develop the disease until their 50s or 60s. Ethnicity. Although whites have the highest risk of the disease, it can occur in any ethnic group. If you’re of Ashkenazi Jewish descent, your risk is even higher. Family history. You’re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. Isotretinoin use. Isotretinoin is a medication sometimes used to treat scarring cystic acne or acne that doesn’t respond to other treatments. It used to be sold under the brand name Accutane, but that brand has been discontinued, and it’s now sold under the brand names Amnesteem, Claravis and Sotret.There is conflicting information as to whether isotretinoin use can increase the risk of inflammatory bowel disease. Some studies have suggested a possible link, while other studies have found no such evidence. The question of whether or not there is a link is further complicated by research that suggests a possible connection between the use of tetracycline class antibiotics and the development of IBD. Many people who have been treated with isotretinoin for acne also have received tetracyclines as part of their acne therapy. Studies that have examined the possible link between isotretinoin and IBD have not addressed the question of whether antibiotics used for acne may have played a role in increasing risk. Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease. It leads to more-severe symptoms and higher risk of complications. If you smoke, stop. Discuss this with your doctor and get help. There are many smoking cessation programs available if you are unable to quit on your own.

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Some pain relievers. These medications include ibuprofen (Advil, Motrin, others), naproxen (Aleve) and aspirin. These medications have been shown to cause gastrointestinal ulceration and may make existing IBD worse. Acetaminophen (Tylenol, others) does not have this effect. Discuss the use of any pain medication with your doctor. Where you live. If you live in an urban area or in an industrialized country, you’re more likely to develop IBD. Because Crohn’s disease occurs more often among people living in cities and industrial nations, it may be that environmental factors, including a diet high in fat or refined foods, play a role in IBD. People living in northern climates also seem to have a greater risk of the disease.

What complications could you have? Inflammatory bowel disease may lead to one or more of the following complications: ■

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Bowel obstruction.Crohn’s disease affects the entire thickness of the intestinal wall. Over time, parts of the bowel can thicken and narrow, which may block the flow of digestive contents through the affected part of your intestine. Some cases require surgery to remove the diseased portion of your bowel. Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your mouth and anus, and in the genital area (perineum) and anus. Bleeding may result. Fistulas. Sometimes ulcers can extend completely through the intestinal wall, creating a fistula. A fistula is an abnormal connection between different parts of your intestine, between your intestine and skin, or between your intestine and another organ, such as the bladder or vagina. When internal fistulas develop, food may bypass areas of the bowel that are necessary for absorption. An external fistula can cause continuous drainage of bowel contents to your skin, and in some cases, a fistula may become infected and form an abscess, a problem that can be life-threatening if left untreated. Fistulas around the anal area (perianal) are the most common kind of fistula. Anal fissure. This is a crack, or cleft, in the anus or in the skin around the anus where infections can occur. It’s often associated with painful bowel movements. This may lead to a perianal fistula. Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. Additionally, anemia is common in people with IBD. Colon cancer. Having IBD disease that affects your colon increases your risk of colon cancer. Other health problems. In addition to inflammation and ulcers in the digestive tract, IBD can cause problems in other parts of the body, such as arthritis, inflammation of the eyes or skin, clubbing of the fingernails, kidney stones, gallstones, and, occasionally, inflammation of the bile ducts. People with long-standing IBD also may develop osteoporosis, a condition that causes weak, brittle bones.

Tests and diagnosis Your doctor will likely diagnose inflammatory bowel disease only after ruling out other possible causes for your signs and symptoms, including ischemic colitis, infection, irritable bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a diagnosis of IBD, you may have one or more of the following tests and procedures:

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Blood tests. Your doctor may suggest blood tests to check for anemia or infection. Tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but these tests can’t definitely make the diagnosis. Stool sample. The presence of white blood cells in your stool indicates an inflammatory disease, possibly IBD. A stool sample can also help rule out other disorders, such as those caused by bacteria, viruses and parasites. Your doctor can also check for a bowel infection, which is more likely to occur in people with IBD. Colonoscopy. This exam allows your doctor to view the inside of your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis. Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the last portion of your colon (sigmoid colon). The test may miss problems higher up in your colon, and it doesn’t give a full picture of how much of the colon has been affected. But if your colon is severely inflamed, your doctor may perform this test instead of a full colonoscopy. Barium enema. This diagnostic test allows your doctor to evaluate your entire large intestine with an X-ray. Barium, a contrast solution, is placed into your bowel using an enema. Sometimes, air is added as well. The barium coats the bowel lining, creating a silhouette image of your rectum, colon and a portion of your small intestine. This test is rarely used anymore, and it can be dangerous because the pressure required to inflate and coat the colon can lead to rupture of the colon. X-ray. A standard X-ray of your abdominal area may be done to rule out toxic megacolon or a perforation of the colon if these conditions are suspected because of severe symptoms. Computerized tomography (CT) scan. A CT scan of your abdomen or pelvis may be performed if your doctor suspects a complication from ulcerative colitis or inflammation of the small intestine that might suggest Crohn’s disease. A CT scan may also reveal how much of the colon is inflamed. Magnetic resonance imaging (MRI). An MRI scanner uses a magnetic field and radio waves to create detailed images of organs and tissues. Most MRI machines are large, tube-shaped magnets. During the test, you lie on a movable table inside the MRI machine. This test is very helpful in diagnosing and managing Crohn’s disease. It’s biggest advantage is that there is no radiation exposure. It’s particularly useful for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MRI enterography). Capsule endoscopy. If you have signs and symptoms that suggest Crohn’s disease but other diagnostic tests are negative, your doctor may perform capsule endoscopy. For this test you swallow a capsule that has a tiny camera in it. The camera takes pictures as it moves through your digestive tract, and the images are transmitted to a computer that you wear on your belt. Your doctor later downloads the images, which are then displayed on a monitor and checked for signs of Crohn’s disease. Once it’s made the trip through your digestive system, the camera exits your body painlessly in your stool. Double-balloon endoscopy. For this test, a longer scope is used to look further into the small bowel where standard endoscopes don’t reach. This technique is useful when capsule endoscopy shows abnormalities but the diagnosis is still in question. It allows for biopsy of the abnormal area. It’s usually performed in specialized endoscopy centers. Small bowel imaging. This test looks at the part of the small bowel that can’t be seen by colonoscopy. You drink a solution containing barium, then X-ray, CT or MRI images are taken of your small intestine. The test can help locate areas of narrowing or inflammation in the small

bowel that are seen in Crohn’s disease. The test can also help your doctor determine which type of inflammatory bowel disease you have.

Treatments and drugs The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. IBD treatment usually involves either drug therapy or surgery.

Anti-inflammatory drugs Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include: ■

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Sulfasalazine (Azulfidine).Sulfasalazine can be effective in reducing symptoms of ulcerative colitis, but it has a number of side effects, including nausea, vomiting, diarrhea, heartburn and headache. Don’t take this medication if you’re allergic to sulfa medications. Mesalamine (Apriso, Asacol, Lialda, others), balsalazide (Colazal) and olsalazine (Dipentum). These medications are available in oral forms, and also in topical forms, such as enemas and suppositories. Which form you take depends on the area of your colon that’s affected. These medications tend to have fewer side effects than sulfasalazine, and are generally very well tolerated. Corticosteroids. Corticosteroids can help reduce inflammation, but they have numerous side effects, including weight gain, excessive facial hair, mood swings, high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts, glaucoma and an increased susceptibility to infections. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn’t respond to other treatments. Corticosteroids aren’t for long-term use and the dose is usually tapered down over two to three months.

Immune system suppressors These drugs also reduce inflammation, but they target your immune system rather than treating inflammation itself. Because immune suppressors can be effective in treating ulcerative colitis, scientists theorize that damage to digestive tissues is caused by your body’s immune response to an invading virus or bacterium or even to your own tissue. By suppressing this response, inflammation is also reduced. Immune system suppressors are associated with a small risk of developing cancer, such as lymphoma. Immunosuppressant drugs include: ■

Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol). Because azathioprine and mercaptopurine act slowly — taking three months or longer to start working — they’re sometimes initially combined with a corticosteroid. With time, they seem to produce benefits on their own and the steroids may be tapered off.

Side effects can include allergic reactions, bone marrow suppression, infections, and inflammation of the liver and pancreas. There also is a small risk of development of cancer with these medications. If you’re taking either of these medications, you’ll need to follow up closely with your doctor and have your blood checked regularly to look for side effects. If you’ve had cancer, discuss this with your

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Cyclosporine (Gengraf, Neoral, Sandimmune). This potent drug is normally reserved for people who don’t respond well to other medications or who face possible surgery because of severe ulcerative colitis. In some cases, cyclosporine may be used to delay surgery until you’re strong enough to undergo the procedure. It may also be used to control signs and symptoms until less toxic drugs start working. Cyclosporine begins working in one to two weeks, but because it has the potential for severe side effects, including kidney damage, seizures and fatal infections, talk to your doctor about the risks and benefits of treatment. There’s also a small risk of cancer with these medications, so let your doctor know if you’ve previously had cancer. Infliximab (Remicade). This drug is specifically for those with moderate to severe ulcerative colitis who don’t respond to or can’t tolerate other treatments. It works quickly to bring on remission, especially for people who haven’t responded well to corticosteroids. It works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF).

Some people with heart failure, people with multiple sclerosis, and people with cancer or a history of cancer can’t take infliximab. The drug has been linked to an increased risk of infection, especially tuberculosis and reactivation of viral hepatitis, and may increase your risk of blood problems and cancer. You’ll need to have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab. ■

Adalimumab (Humira).Adalimumab works similarly to infliximab by blocking TNF for people with moderate to severe Crohn’s disease. It can be used soon after you’re diagnosed if you have a fistula, or if you have more severe Crohn’s disease. It also may be used after other medications have failed to improve your symptoms. Adalimumab may be used instead of infliximab or certiluzimab, or it can be used if infliximab or certiluzimab stop working. Adalimumab may reduce the signs and symptoms of Crohn’s disease and may cause remission.

However, adalimumab, like infliximab, carries a small risk of complications, including tuberculosis and serious fungal infections. Your doctor will give you a skin test for tuberculosis, obtain a chest Xray and test you for hepatitis before you begin adalimumab treatment. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose and upper respiratory infection. ■

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Certolizumab pegol (Cimzia). Approved by the Food and Drug Administration for the treatment of Crohn’s disease, certolizumab pegol works by inhibiting TNF. Certolizumab pegol is prescribed for people with moderate to severe Crohn’s disease. Certolizumab pegol may be used instead of infliximab, or it can be used if infliximab or adalimumab stop working. Common side effects include headache, upper respiratory infections, abdominal pain, nausea and reactions at the injection site. Because this drug affects your immune system, you’re also at risk of becoming seriously ill with certain infections, such as tuberculosis. Your doctor will give you a skin test for tuberculosis, obtain a chest X-ray and test you for hepatitis before you begin certiluzimab pegol. Methotrexate (Rheumatrex)zThis drug, which is used to treat cancer, psoriasis and rheumatoid arthritis, is sometimes used for people with Crohn’s disease who don’t respond well to other medications. Short-term side effects include nausea, fatigue and diarrhea, and rarely, it can cause potentially life-threatening pneumonia. Long-term use can lead to scarring of the liver and sometimes to cancer. Avoid becoming pregnant while taking methotrexate. If you’re taking this

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medication, follow up closely with your doctor and have your blood checked regularly to look for side effects. Natalizumab (Tysabri). This drug works by inhibiting certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Natalizumab is approved for people with moderate to severe Crohn’s disease with evidence of inflammation and who aren’t responding well to other conventional Crohn’s disease therapies. Because the drug is associated with a rare, but serious, risk of multifocal leukoencephalopathy — a brain infection that usually leads to death or severe disability — you must be enrolled in a special program to use it.

Antibiotics Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn’s disease. Researchers also believe antibiotics help reduce harmful intestinal bacteria and suppress the intestine’s immune system, which can trigger symptoms. However, there’s no strong evidence that antibiotics are effective for Crohn’s disease. Frequently prescribed antibiotics include: ■

Metronidazole (Flagyl). Once the most commonly used antibiotic for Crohn’s disease,

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metronidazole can cause serious side effects, including numbness and tingling in your hands and feet and, occasionally, muscle pain or weakness. Ciprofloxacin (Cipro). This drug, which improves symptoms in some people with Crohn’s disease, is now generally preferred to metronidazole. A rare, but possible side effect of this medication is tendon rupture.

Other medications In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your inflammatory bowel disease, your doctor may recommend one or more of the following: ■

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Anti-diarrheals. A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium) may be effective. Laxatives. In some cases, swelling may cause your intestines to narrow, leading to constipation. Talk to your doctor before taking any laxatives, because even those sold over-the-counter may be too harsh for your system. Pain relievers.For mild pain, your doctor may recommend acetaminophen (Tylenol, others). Avoid ibuprofen (Advil, Motrin, others), naproxen (Aleve) and aspirin. These are likely to make your symptoms worse. Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of anemia once your bleeding has stopped or diminished. Nutrition. Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn’s disease. This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term. B-12 shots.Vitamin B-12 helps prevent anemia, promotes normal growth and development, and

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is essential for proper nerve function. It’s absorbed in the terminal ileum, a part of the small intestine often affected by Crohn’s disease. If inflammation of your terminal ileum is interfering with your ability to absorb this vitamin, you may need monthly B-12 shots for life. You’ll also need lifelong B-12 injections if your terminal ileum has been removed during surgery. Calcium and vitamin D supplements. You may need to take a calcium supplement with added vitamin D. This is because Crohn’s disease and steroids used to treat it can increase your risk of osteoporosis. Ask your doctor if a calcium supplement is right for you.

Surgery If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your IBD signs and symptoms, your doctor may recommend surgery. ■

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Surgery for ulcerative colitis. Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy). In the past, after this surgery you would wear a small bag over an opening in your abdomen (ileostomy) to collect stool. But a procedure called ileoanal anastomosis eliminates the need to wear a bag and is the preferred procedure for most people. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus. This allows you to expel waste more normally. Surgery for Crohn’s disease. In Crohn’s disease, surgery can provide years of remission at best. At the least, it may provide a temporary improvement in your signs and symptoms. During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. In addition, surgery may also be used to close fistulas and drain abscesses. A common procedure for Crohn’s is strictureplasty, which widens a segment of the intestine that has become too narrow.

Cancer surveillance People who have inflammatory bowel disease have an increased risk of colon cancer. Talk with your doctor about how often you should be screened.

Lifestyle and home remedies Sometimes you may feel helpless when facing inflammatory bowel disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

Diet There’s no firm evidence that what you eat causes inflammatory bowel disease. But certain foods and beverages can aggravate your symptoms, especially during a flare-up. It’s a good idea to try eliminating from your diet anything that seems to make your signs and symptoms worse. Here are some suggestions: ■

Limit dairy products. If milk or other dairy products aggravate your symptoms, you may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. If so, you may want to try an enzyme product, such as Lactaid, to help break down lactose. In some cases, you may need to eliminate dairy foods completely. Keep in mind that with limiting your dairy

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intake, you’ll need to find other sources of calcium, such as supplements. Experiment with fiber. For most people, high-fiber foods, such as fresh fruits and vegetables and whole grains, are the foundation of a healthy diet. But if you have inflammatory bowel disease, fiber may make diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. Check with your doctor before adding significant amounts of fiber to your diet. Avoid problem foods. Eliminate any other foods that seem to make your symptoms worse. These may include “gassy” foods, such as beans, cabbage and broccoli, raw fruit juices and fruits, popcorn, caffeine, and carbonated beverages. Eat small meals. You may find that you feel better eating five or six small meals rather than two or three larger ones. Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas. Consider multivitamins. Because inflammatory bowel disease can interfere with your ability to absorb nutrients and because your diet may be limited, vitamin and mineral supplements can play a key role in supplying missing nutrients. They don’t provide essential protein and calories, however, and shouldn’t be a substitute for meals. Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Smoking Smoking increases your risk of developing Crohn’s disease, and once you have it, smoking can make the condition worse. People with Crohn’s disease who smoke are more likely to have relapses, need medications and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.

Stress Although stress doesn’t cause inflammatory bowel disease, it can make your signs and symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one. When you’re stressed, your normal digestive process can change, causing your stomach to empty more slowly and secrete more acids. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself. Although it’s not always possible to avoid stress, you can learn ways to help manage it. Some of these include: ■

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Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that’s right for you. Biofeedback. This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the help of a feedback machine. You’re then taught how to produce these changes yourself. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers.

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Regular relaxation and breathing exercises. An effective way to cope with stress is to perform relaxation and breathing exercises. You can take classes in yoga and meditation or practice at home using books, CDs or DVDs. Hypnosis. Hypnosis may reduce abdominal pain and bloating. A trained professional can teach you how to enter a relaxed state. Other techniques. Set aside time every day for any activity you find relaxing — listening to music, reading, playing computer games or just soaking in a warm bath.

Alternative medicine Many people with inflammatory bowel disease have used some form of alternative or complementary therapy. Side effects and ineffectiveness of conventional therapies may be among the reasons for seeking alternative care. These therapies generally aren’t regulated by the Food and Drug Administration. Manufacturers can claim that their therapies are safe and effective, but don’t need to prove it. Because even natural herbs can have side effects and cause dangerous interactions, talk to your doctor before trying any alternative or complementary therapies. Currently, no alternative therapies have good evidence supporting their use in treating IBD, but some that may eventually prove beneficial include: ■

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Probiotics. Because bacteria in the gut have been implicated in ulcerative colitis, researchers suspect that adding more of the beneficial bacteria (probiotics) that are normally found in the gut might help combat the disease. Fish oil. Fish oil acts as an anti-inflammatory, but studies on its possible benefits for people with ulcerative colitis have had conflicting results. Aloe vera. Aloe vera juice has been purported to have an anti-inflammatory effect for people with ulcerative colitis, but there’s no strong evidence to back this claim. In addition, when ingested, aloe vera can have a laxative effect. Acupuncture. Several studies have found acupuncture to be of benefit to people with ulcerative colitis. The procedure involves the insertion of fine needles into the skin, which may stimulate the release of the body’s natural painkillers. Curcumin. This compound comes from the spice turmeric. Curcumin combined with standard ulcerative colitis therapies, such as corticosteroids or sulfasalazine, has helped improve symptoms and allowed smaller doses of the standard drugs to be used. However, this evidence comes from two small studies. More research is needed before this treatment can be recommended.

Crohn’s Disease Crohn’s disease is an inflammatory bowel disease (IBD). It causes inflammation of the lining of your digestive tract, which can lead to abdominal pain, severe diarrhea and even malnutrition. Inflammation caused by Crohn’s disease can involve different areas of the digestive tract in different people.

The inflammation caused by Crohn’s disease often spreads deep into the layers of affected bowel tissue. Like ulcerative colitis, another common IBD, Crohn’s disease can be both painful and debilitating, and sometimes may lead to life-threatening complications. While there’s no known cure for Crohn’s disease, therapies can greatly reduce the signs and symptoms of Crohn’s disease and even bring about long-term remission. With treatment, many people with Crohn’s disease are able to function well.

What are the symptoms of Crohn's disease? Inflammation of Crohn’s disease may involve different areas in different people. In some people, just the small intestine is affected. In others, it’s confined to the colon (part of the large intestine). The most common areas affected by Crohn’s disease are the last part of the small intestine (ileum) and the colon. Inflammation may be confined to the bowel wall, which can lead to scarring (stenosis), or inflammation may spread through the bowel wall (fistula). Signs and symptoms of Crohn’s disease can range from mild to severe and may develop gradually or come on suddenly, without warning. You may also have periods of time when you have no signs or symptoms (remission). When the disease is active, signs and symptoms may include: ■

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Diarrhea. The inflammation that occurs in Crohn’s disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can’t completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. Diarrhea is a common problem for people with Crohn’s. Abdominal pain and cramping. Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of contents through your digestive tract and may lead to pain and cramping. Mild Crohn’s disease usually causes slight to moderate intestinal discomfort, but in more-serious cases, the pain may be severe and include nausea and vomiting. Blood in your stool. Food moving through your digestive tract may cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don’t see (occult blood). Ulcers. Crohn’s disease can cause small sores on the surface of the intestine that eventually become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You may also have ulcers in your mouth similar to canker sores. Reduced appetite and weight loss. Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.

Other signs and symptoms People with severe Crohn’s disease may also experience: ■

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Fever Fatigue Arthritis Eye inflammation Mouth sores Skin disorders

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Inflammation of the liver or bile ducts Delayed growth or sexual development, in children

When to see a doctor See your doctor if you have persistent changes in your bowel habits or if you have any of the signs and symptoms of Crohn’s disease, such as: ■

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Abdominal pain Blood in your stool Ongoing bouts of diarrhea that don’t respond to over-the-counter (OTC) medications Unexplained fever lasting more than a day or two

What are the causes of Crohn's disease? The exact cause of Crohn’s disease remains unknown. Previously, diet and stress were suspected, but now doctors know that although these factors may aggravate existing Crohn’s disease, they don’t cause it. Now, researchers believe that a number of factors, such as heredity and a malfunctioning immune system, play a role in the development of Crohn’s disease. ■

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Immune system. It’s possible that a virus or bacterium may trigger Crohn’s disease. When your immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too. Heredity. Crohn’s is more common in people who have family members with the disease, leading experts to suspect that one or more genes may make people more susceptible to Crohn’s disease. However, most people with Crohn’s disease don’t have a family history of the disease.

What is the risk factor? Risk factors for Crohn’s disease may include: ■

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Age. Crohn’s disease can occur at any age, but you’re likely to develop the condition when you’re young. Most people who develop Crohn’s disease are diagnosed before they’re 30 years old. Ethnicity. Although whites have the highest risk of the disease, it can affect any ethnic group. If you’re of Eastern European (Ashkenazi) Jewish descent, your risk is even higher. Family history. You’re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. As many as 1 in 5 people with Crohn’s disease has a family member with the disease. Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease. Smoking also leads to more severe disease and a greater risk of surgery. If you smoke, stop. Discuss this with your doctor and get help. There are many smokingcessation programs available if you are unable to quit on your own. Where you live. If you live in an urban area or in an industrialized country, you’re more likely to develop Crohn’s disease. Because Crohn’s disease occurs more often among people living in cities and industrial nations, it may be that environmental factors, including a diet high in fat or refined foods, play a role in Crohn’s disease. People living in northern climates also seem to have a greater

risk of the disease.

What complications could you have? Crohn’s disease may lead to one or more of the following complications: ■

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Bowel obstruction.Crohn’s disease affects the thickness of the intestinal wall. Over time, parts of the bowel can thicken and narrow, which may block the flow of digestive contents through the affected part of your intestine. Some cases require surgery to remove the diseased portion of your bowel. Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your mouth and anus, and in the genital area (perineum) and anus. Fistulas. Sometimes ulcers can extend completely through the intestinal wall, creating a fistula — an abnormal connection between different parts of your intestine, between your intestine and skin, or between your intestine and another organ, such as the bladder or vagina. When internal fistulas develop, food may bypass areas of the bowel that are necessary for absorption. An external fistula can cause continuous drainage of bowel contents to your skin, and in some cases, a fistula may become infected and form an abscess, a problem that can be life-threatening if left untreated. Fistulas around the anal area (perianal) are the most common kind of fistula. Anal fissure. This is a crack, or cleft, in the anus or in the skin around the anus where infections can occur. It’s often associated with painful bowel movements. This may lead to a perianal fistula. Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. Additionally, anemia is common in people with Crohn’s disease. Colon cancer. Having Crohn’s disease that affects your colon increases your risk of colon cancer. Other health problems. In addition to inflammation and ulcers in the digestive tract, Crohn’s disease can cause problems in other parts of the body, such as arthritis, inflammation of the eyes or skin, clubbing of the fingernails, kidney stones, gallstones and, occasionally, inflammation of the bile ducts. People with long-standing Crohn’s disease also may develop osteoporosis, a condition that causes weak, brittle bones.

Tests and diagnosis Your doctor will likely diagnose Crohn’s disease only after ruling out other possible causes for your signs and symptoms, including irritable bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a diagnosis of Crohn’s disease, you may have one or more of the following tests and procedures: ■

Blood tests. Your doctor may suggest blood tests to check for anemia — a condition in which there aren’t enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection. Two tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but not everyone with Crohn’s disease has these antibodies. While your doctor may order these tests, a positive finding doesn’t mean you have Crohn’s disease and a negative finding doesn’t mean that you’re free of the disease. Because these tests aren’t yet definitive, the American College of Gastroenterology doesn’t

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currently recommend antibody or genetic testing for Crohn’s disease. Fecal occult blood test. You may need to provide a stool sample so that your doctor can test for blood in your stool. Colonoscopy. This test allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help confirm a diagnosis. Some people have clusters of inflammatory cells called granulomas, which help confirm the diagnosis of Crohn’s disease because granulomas don’t occur with ulcerative colitis. Risks of colonoscopy include perforation of the colon wall and bleeding. Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last section of your colon. Computerized tomography (CT). You may have a CT scan, a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel that can’t be seen with other tests. Your doctor may order this scan to better understand the location and extent of your disease or to check for complications such as partial blockages, abscesses or fistulas. Although not invasive, a CT scan exposes you to more radiation than a conventional X-ray does. CT enterography is a special CT scan that provides better images of the small bowel. This test has replaced barium X-rays in many medical centers. Magnetic resonance imaging. An MRI scanner uses a magnetic field and radio waves to create detailed images of organs and tissues. Most MRI machines are large, tube-shaped magnets. During the test, you lie on a movable table inside the MRI machine. This test is very helpful in diagnosing and managing Crohn’s disease. It’s biggest advantage is that there is no radiation exposure. It’s particularly useful for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MRI enterography). Capsule endoscopy. If you have signs and symptoms that suggest Crohn’s disease but other diagnostic tests are negative, your doctor may perform capsule endoscopy. For this test you swallow a capsule that has a camera in it. The camera takes pictures, which are transmitted to a computer that you wear on your belt. The images are then downloaded, displayed on a monitor and checked for signs of Crohn’s disease. Once it’s made the trip through your digestive system, the camera exits your body painlessly in your stool. Capsule endoscopy is generally very safe, but if you have a partial blockage in the bowel, there’s a slight chance the capsule may become lodged in your intestine. In addition, the images provided by capsule endoscopy may not be detailed enough. Endoscopy with biopsy is often still needed to confirm the diagnosis of Crohn’s disease and to exclude other causes of your symptoms. Double balloon endoscopy. For this test, a longer scope is used to look further into the small bowel where standard endoscopes don’t reach. This technique is useful when capsule endoscopy shows abnormalities, but the diagnosis is still in question. It allows for biopsy of the abnormal area. It’s usually performed in specialized endoscopy centers. Small bowel imaging. This test looks at the part of the small bowel that can’t be seen by colonoscopy. After you drink a solution containing barium, X-ray, CT or MRI images are taken of your small intestine. The test can help locate areas of narrowing or inflammation in the small bowel that are seen in Crohn’s disease. The test can also help your doctor determine which type of inflammatory bowel disease you have. Barium enema. This diagnostic test allows your doctor to evaluate your large intestine with an Xray. Before the test, you receive an enema with a contrast solution containing barium. The barium

dye coats the lining of the bowel, creating a silhouette of your rectum, colon and a portion of your small intestine that’s visible on an X-ray. This test is rarely done anymore because of the availability of colonoscopy and CT scanning.

Treatments and drugs There is currently no cure for Crohn’s disease, and there is no one treatment that works for everyone. The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. It is also to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for Crohn’s disease usually involves drug therapy or, in certain cases, surgery.

Anti-inflammatory drugs Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include: ■

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Sulfasalazine (Azulfidine). Although this drug isn’t always effective for treating Crohn’s disease, it may be of some help for Crohn’s that affects the colon. It has a number of side effects, including nausea, vomiting, heartburn and headache. Don’t take this medication if you’re allergic to sulfa medications. Mesalamine (Asacol, Rowasa). This medication is less likely to cause side effects than sulfasalazine, but possible side effects include nausea, vomiting, heartburn, diarrhea and headache. You take it in tablet form or use it rectally in the form of an enema or suppository, depending on which part of your colon is affected. This medication is generally ineffective for disease involving the small intestine. Corticosteroids. Corticosteroids can help reduce inflammation anywhere in your body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More-serious side effects include high blood pressure, diabetes, osteoporosis, bone fractures, cataracts, glaucoma and an increased susceptibility to infections. Long-term use of corticosteroids in children can lead to stunted growth.Also, these medications don’t work for everyone with Crohn’s disease. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn’t respond to other treatments. A newer type of corticosteroid, budesonide (Entocort EC), works faster than do traditional steroids and appears to produce fewer side effects. Entocort EC is effective only in Crohn’s disease that involves the lower small intestine and the first part of the large intestine.Corticosteroids aren’t for long-term use. But, they can be used for short-term (three to four months) symptom improvement and to induce remission. Corticosteroids also may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission.

Immune system suppressors These drugs also reduce inflammation, but they target your immune system rather than directly treating inflammation. By suppressing the immune response, inflammation is also reduced.

Sometimes, these drugs are used in combination. For example, a combination of azathioprine and infliximab has been shown to work better than either drug alone in some people. Immunosuppressant drugs include: ■

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Azathioprine (Imuran) and mercaptopurine (Purinethol).These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. If you’re taking either of these medications, you’ll need to follow up closely with your doctor and have your blood checked regularly to look for side effects, such as a lowered resistance to infection. These drugs may also cause nausea and vomiting. Infliximab (Remicade). This drug is for adults and children with moderate to severe Crohn’s disease. It may be used soon after diagnosis, particularly if your doctor suspects that you’re likely to have more severe Crohn’s disease or if you have a fistula. It’s also used after other drugs have failed. It may be combined with an immunosuppressant in some people, but this practice is somewhat controversial. Infliximab works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract.Some people with heart failure, people with multiple sclerosis, and those with cancer or a history of cancer can’t take infliximab or the other members of this class (adalimumab and certolizumab pegol). Talk to your doctor about the potential risks of taking infliximab. Tuberculosis and other serious infections have been associated with the use of immune-suppressing drugs. If you have an active infection, don’t take these medications. You should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab. Adalimumab (Humira). Adalimumab works similarly to infliximab by blocking TNF for people with moderate to severe Crohn’s disease. It can be used soon after you’re diagnosed if you have a fistula, or if you have more severe Crohn’s disease. It also may be used after other medications have failed to improve your symptoms. Adalimumab may be used instead of infliximab or certoluzimab pegol, or it can be used if infliximab or certoluzimab pegol stop working. Adalimumab may reduce the signs and symptoms of Crohn’s disease and may cause remission.However, adalimumab, like infliximab, carries a small risk of infections, including tuberculosis and serious fungal infections. You should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose, and upper respiratory infection. Certolizumab pegol (Cimzia). Approved by the Food and Drug Administration (FDA) for the treatment of Crohn’s disease, certolizumab pegol works by inhibiting TNF. Certolizumab pegol is prescribed for people with moderate to severe Crohn’s disease. Certolizumab pegol may be used instead of infliximab or adalimumab, or it can be used if infliximab or adalimumab stop working. Common side effects include headache, upper respiratory infections, abdominal pain, nausea and reactions at the injection site. Like other medications that inhibit TNF, because this drug affects your immune system, you’re also at risk of becoming seriously ill with certain infections, such as tuberculosis. You should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before starting certolizumab pegol. Methotrexate (Rheumatrex). This drug, which is used to treat cancer, psoriasis and rheumatoid arthritis, is sometimes used for people with Crohn’s disease who don’t respond well to other medications. Short-term side effects include nausea, fatigue and diarrhea, and rarely, it can cause potentially life-threatening pneumonia. Long-term use can lead to scarring of the liver and

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sometimes to cancer. Avoid becoming pregnant while taking methotrexate. If you’re taking this medication, follow up closely with your doctor and have your blood checked regularly to look for side effects. Cyclosporine (Gengraf, Neoral, Sandimmune). This potent drug, often used to help heal Crohn’s-related fistulas, is normally reserved for people who haven’t responded well to other medications. Cyclosporine has the potential for serious side effects, such as kidney and liver damage, seizures, and fatal infections. This medication isn’t for long-term use. Natalizumab (Tysabri). This drug works by inhibiting certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Blocking these molecules is thought to reduce chronic inflammation that occurs when they bind to your intestinal cells. Natalizumab is approved for people with moderate to severe Crohn’s disease with evidence of inflammation and who aren’t responding well to other conventional Crohn’s disease therapies including TNF blockers and immunomodulators. Because the drug is associated with a rare, but serious, risk of multifocal leukoencephalopathy — a brain infection that usually leads to death or severe disability — you must be enrolled in a special restricted distribution program to use it.

Medications and cancer risk Immune system suppressors also are associated with a small risk of developing cancer such as lymphoma. These include azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab, certolizumab pegol and others. The risk may be due to the immune system suppression that these medications cause. While these medications do increase risk, they may be necessary for people with Crohn’s disease to improve quality of life and avoid surgery or hospitalization. Work with your doctor to determine which medications are right for you.

Antibiotics Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn’s disease. Researchers also believe antibiotics help reduce harmful intestinal bacteria and suppress the intestine’s immune system, which can trigger symptoms. However, there’s no strong evidence that antibiotics are effective for Crohn’s disease. Frequently prescribed antibiotics include: ■

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Metronidazole (Flagyl). Once the most commonly used antibiotic for Crohn’s disease, metronidazole can cause serious side effects, including numbness and tingling in your hands and feet and, occasionally, muscle pain or weakness. If these effects occur, stop the medication and call your doctor. Ciprofloxacin (Cipro). This drug, which improves symptoms in some people with Crohn’s disease, is now generally preferred to metronidazole. A rare side effect of this medication is tendon rupture.

Other medications In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your Crohn’s disease, your doctor may recommend one or more of the following: ■

Anti-diarrheals. A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more

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severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheals with caution and only after consulting your doctor. Laxatives. In some cases, swelling may cause your intestines to narrow, leading to constipation. Talk to your doctor before taking any laxatives, because even those sold over-the-counter may be too harsh for your system. Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). Avoid aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve). These are likely to make your symptoms worse. Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of anemia once your bleeding has stopped or diminished. Nutrition. Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn’s disease. This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term. However, once regular feeding is restarted, your signs and symptoms may return. Your doctor may use nutrition therapy short term and combine it with other medications, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier for surgery or when other medications fail to control symptoms. Your doctor may also recommend a low residue or low-fiber diet if you have a narrowed bowel (stricture) to try to reduce the risk of a blockage. A low residue diet is one that’s designed to reduce the size and number of your stools. Vitamin B-12 shots. Vitamin B-12 helps prevent anemia, promotes normal growth and development, and is essential for proper nerve function. It’s absorbed in the terminal ileum, a part of the small intestine often affected by Crohn’s disease. If inflammation of your terminal ileum is interfering with your ability to absorb this vitamin, you may need monthly B-12 shots for life. You’ll also need lifelong B-12 injections if your terminal ileum has been removed during surgery. Calcium and vitamin D supplements. You may need to take a calcium supplement with added vitamin D. This is because Crohn’s disease and steroids used to treat it can increase your risk of osteoporosis. Ask your doctor if a calcium supplement is right for you.

Future medications New medications are in development and in clinical trial. If your Crohn’s disease isn’t well controlled with current medications, ask your doctor if there are clinical trials available to you.

Surgery If diet and lifestyle changes, drug therapy or other treatments don’t relieve your signs and symptoms, your doctor may recommend surgery. During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. In addition, surgery may also be used to close fistulas and drain abscesses. A common procedure for Crohn’s is strictureplasty, which widens a segment of the intestine that has become too narrow. The benefits of surgery for Crohn’s are usually temporary. The disease often recurs, frequently near the reconnected tissue or elsewhere in the digestive tract. Up to 3 of 4 people with Crohn’s disease

eventually need some type of surgery. Many will also need a second procedure or more. The best approach is to follow surgery with medication to minimize the risk of recurrence.

Cancer surveillance Screening for colon cancer may need to be done more frequently because people who have Crohn’s disease that affects the colon have an increased risk of colon cancer. General colon cancer screening guidelines call for a colonoscopy every 10 years beginning at age 50. Ask your doctor if you need to have this test done sooner and more frequently.

Lifestyle and home remedies Sometimes you may feel helpless when facing Crohn’s disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

Diet There’s no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up. If you think eating certain foods make your condition worse, keep a food diary to keep track of what you’re eating as well as how you feel. If you discover some foods are causing your symptoms to flare, it’s a good idea to try eliminating those foods. Here are some suggestions that may help: ■

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Limit dairy products. Like many people with inflammatory bowel disease, you may find that problems, such as diarrhea, abdominal pain and gas, improve when you limit or eliminate dairy products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. If so, limiting dairy or using an enzyme product, such as Lactaid, will help break down lactose. Try low-fat foods. If you have Crohn’s disease of the small intestine, you may not be able to digest or absorb fat normally. Instead, fat passes through your intestine, making your diarrhea worse. Foods that may be especially troublesome include butter, margarine, cream sauces and fried foods. Limit fiber, if it’s a problem food. For most people, high-fiber foods, such as fresh fruits and vegetables and whole grains, are the foundation of a healthy diet. But if you have inflammatory bowel disease, fiber may make diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. You may also find that you can tolerate some fruits and vegetables, but not others. In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn. Avoid problem foods. Eliminate any other foods that seem to make your signs and symptoms worse. These may include “gassy” foods such as beans, cabbage and broccoli, raw fruit juices and fruits, spicy food, popcorn, alcohol, and foods and drinks that contain caffeine, such as chocolate and soda. Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones. Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas. Consider multivitamins. Because Crohn’s disease can interfere with your ability to absorb

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nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements. Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Smoking Smoking increases your risk of developing Crohn’s disease, and once you have it, smoking can make the condition worse. People with Crohn’s disease who smoke are more likely to have relapses, need medications and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.

Stress Although stress doesn’t cause Crohn’s disease, it can make your signs and symptoms worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one. When you’re stressed, your normal digestive process changes. Your stomach empties more slowly and secretes more acid. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself. Although it’s not always possible to avoid stress, you can learn ways to help manage it. Some of these include: ■

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Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that’s right for you. Biofeedback. This stress-reduction technique may help you reduce muscle tension and slow your heart rate with the help of a feedback machine. You’re then taught how to produce these changes without feedback from the machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers. Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. You can take classes in yoga and meditation or use books, CDs or DVDs at home.

Alternative medicine Many people with digestive disorders have used some form of complementary or alternative therapy. Some commonly used therapies include: ■

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Herbal and nutritional supplements Probiotics Fish oil Acupuncture

Side effects and ineffectiveness of conventional therapies are primary reasons for seeking alternative care.

The majority of alternative therapies aren’t regulated by the FDA. Manufacturers can claim that their therapies are safe and effective but don’t need to prove it. In some cases that means you’ll end up paying for products that don’t work. For example, studies done on fish oil and on probiotics for the treatment of Crohn’s haven’t shown benefits to using these products. What’s more, even natural herbs and supplements can have side effects and cause dangerous interactions. Tell your doctor if you decide to try any herbal supplement. Some people may find acupuncture or hypnosis helpful for the management of Crohn’s, but neither therapy has been well studied for this use. Unlike probiotics — which are beneficial live bacteria that you consume — prebiotics are natural compounds found in plants, such as artichokes, that help fuel beneficial intestinal bacteria. An initial study on prebiotics had promising results. More studies are under way.

Ulcerative colitis Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes longlasting inflammation in part of your digestive tract. Like Crohn’s disease, another common IBD, ulcerative colitis can be debilitating and sometimes can lead to life-threatening complications. Because ulcerative colitis is a chronic condition, symptoms usually develop over time, rather than suddenly. Ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. It occurs only through continuous stretches of your colon, unlike Crohn’s disease, which occurs anywhere in the digestive tract and often spreads deeply into the affected tissues. There’s no known cure for ulcerative colitis, but therapies are available that may dramatically reduce the signs and symptoms of ulcerative colitis and even bring about a long-term remission.

What are the symptoms of Ulcerative colitis? Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. For these reasons, doctors often classify ulcerative colitis according to its location. Here are the signs and symptoms that may accompany ulcerative colitis, depending on its classification: ■

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Ulcerative proctitis. In this form of ulcerative colitis, inflammation is confined to the area closest to the anus (rectum), and for some people, rectal bleeding may be the only sign of the disease. Others may have rectal pain and a feeling of urgency. This form of ulcerative colitis tends to be the mildest. Proctosigmoiditis. This form involves the rectum and the lower end of the colon, known as the sigmoid colon. Bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus) are common problems associated with this form of the disease.

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Left-sided colitis. As the name suggests, inflammation extends from the rectum up through the sigmoid and descending colon, which are located in the upper left part of the abdomen. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss. Pancolitis. Affecting more than the left colon and often the entire colon, pancolitis causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss. Fulminant colitis. This rare, life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhea and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications, including colon rupture and toxic megacolon, a condition that causes the colon to rapidly expand.

The course of ulcerative colitis varies, with periods of acute illness often alternating with periods of remission. But over time, the severity of the disease usually remains the same. Most people with a milder condition, such as ulcerative proctitis, won’t go on to develop more-severe signs and symptoms.

When to see a doctor See your doctor if you experience a persistent change in your bowel habits or if you have any of the signs and symptoms of ulcerative colitis, such as: ■

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Abdominal pain Blood in your stool Ongoing bouts of diarrhea that don’t respond to over-the-counter (OTC) medications An unexplained fever lasting more than a day or two

Although ulcerative colitis usually isn’t fatal, it’s a serious disease that, in some cases, may cause life-threatening complications.

What are the causes of Ulcerative colitis? Like Crohn’s disease, ulcerative colitis causes inflammation and ulcers in your intestine. But unlike Crohn’s, which can affect the colon in various, separate sections, ulcerative colitis usually affects one continuous section of the inner lining of the colon beginning with the rectum. No one is quite sure what triggers ulcerative colitis, but there’s a consensus as to what doesn’t. Researchers no longer believe that stress is the main cause, although stress can often aggravate symptoms. Instead, current thinking focuses on the following possibilities: ■

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Immune system. Some scientists think a virus or bacterium may trigger ulcerative colitis. The digestive tract becomes inflamed when your immune system tries to fight off the invading microorganism (pathogen). It’s also possible that inflammation may stem from an autoimmune reaction in which your body mounts an immune response even though no pathogen is present. Heredity. Because you’re more likely to develop ulcerative colitis if you have a parent or sibling with the disease, scientists suspect that genetic makeup may play a contributing role. However, most people who have ulcerative colitis don’t have a family history of this disorder.

What is the risk factor? Ulcerative colitis affects about the same number of women and men. Risk factors may include: ■

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Age. Ulcerative colitis usually begins before the age of 30. But, it can occur at any age, and some people may not develop the disease until their 50s or 60s. Race or ethnicity. Although whites have the highest risk of the disease, it can occur in any race. If you’re of Ashkenazi Jewish descent, your risk is even higher. Family history. You’re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. Isotretinoin use. Isotretinoin is a medication sometimes used to treat scarring cystic acne or acne that doesn’t respond to other treatments. It used to be sold under the brand name Accutane, but that brand has been discontinued, and it’s now sold under the brand names Amnesteem, Claravis and Sotret.There is conflicting information as to whether isotretinoin use can increase the risk of inflammatory bowel disease. Some studies have suggested a possible link, while other studies have found no such evidence. The question of whether or not there is a link is further complicated by research that suggests a possible connection between the use of tetracycline class antibiotics and the development of IBD. Many people who have been treated with isotretinoin for acne also have received tetracyclines as part of their acne therapy. Studies that have examined the possible link between isotretinoin and IBD have not addressed the question of whether antibiotics used for acne may have played a role in increasing risk.

What complications you could have? Possible complications of ulcerative colitis include: ■

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Severe bleeding A hole in the colon (perforated colon) Severe dehydration Liver disease (rare) Kidney stones Osteoporosis Inflammation of your skin, joints and eyes An increased risk of colon cancer A rapidly swelling colon (toxic megacolon)

Tests and diagnosis Your doctor will likely diagnose ulcerative colitis only after ruling out other possible causes for your signs and symptoms, including Crohn’s disease, ischemic colitis, infection, irritable bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures: ■

Blood tests. Your doctor may suggest blood tests to check for anemia or infection. Tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but these tests can’t definitely make the diagnosis.

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Stool sample. The presence of white blood cells in your stool indicates an inflammatory disease, possibly ulcerative colitis. A stool sample can also help rule out other disorders, such as those caused by bacteria, viruses and parasites. In particular, infection with the bacterium Clostridium difficile can be responsible for diarrhea, but it’s also more common among people with ulcerative colitis. Your doctor can also check for a bowel infection, which is more likely to occur in people with ulcerative colitis. Colonoscopy. This exam allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis. Flexible sigmoidoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the sigmoid, the last portion of your colon. The test may miss problems higher up in your colon and it doesn’t give a full picture of how much of the colon has been affected. But, if your colon is severely inflamed, your doctor may perform this test instead of a full colonoscopy. Barium enema. This diagnostic test allows your doctor to evaluate your entire large intestine with an X-ray. Barium, a contrast solution, is placed into your bowel using an enema. Sometimes air is added as well. The barium coats the lining, creating a silhouette of your rectum, colon and a portion of your small intestine. This test is rarely used anymore, and it can be dangerous because the pressure required to inflate and coat the colon can lead to rupture of the colon. For people with severe symptoms, flexible sigmoidoscopy combined with a CT scan is a better alternative. X-ray. A standard X-ray of your abdominal area may be done to rule out toxic megacolon or a perforation if these conditions are suspected because of severe symptoms. CT scan. A CT scan of your abdomen or pelvis may be performed if your doctor suspects a complication from ulcerative colitis or inflammation of the small intestine that might suggest Crohn’s disease. A CT scan may also reveal how much of the colon is inflamed.

Treatments and drugs The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Ulcerative colitis treatment usually involves either drug therapy or surgery. Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.

Anti-inflammatory drugs Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include: ■

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Sulfasalazine (Azulfidine). Sulfasalazine can be effective in reducing symptoms of ulcerative colitis, but it has a number of side effects, including nausea, vomiting, diarrhea, heartburn and headache. Don’t take this medication if you’re allergic to sulfa medications. Mesalamine (Asacol, Lialda, others), balsalazide (Colazal) and olsalazine (Dipentum). These medications are available in oral forms and also in topical forms, such as enemas and suppositories. Which form you take depends on the area of your colon that’s affected

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by ulcerative colitis. These medications tend to have fewer side effects than sulfasalazine and are generally very well tolerated. Your doctor may prescribe a combination of two different forms, such as an oral medication and an enema or suppository. Mesalamine can relieve signs and symptoms in more than 90 percent of people with mild ulcerative colitis. People with proctitis tend to respond better to combination therapy with oral mesalamine and suppositories. For left-sided colitis, a combination of oral mesalamine and mesalamine enemas seems to work better than either agent alone if symptoms are mild to moderate. Rare side effects include headache, kidney problems and pancreas problems (pancreatitis). Corticosteroids. Corticosteroids can help reduce inflammation, but they have numerous side effects, including weight gain, excessive facial hair, mood swings, high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts, glaucoma and an increased susceptibility to infections. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn’t respond to other treatments. Corticosteroids aren’t for long-term use, and the dose is usually tapered down over two to three months.

They may also be used in conjunction with other medications as a means to induce remission. For example, corticosteroids may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission. Occasionally, your doctor may also prescribe short-term use of steroid enemas to treat disease in your lower colon or rectum.

Immune system suppressors These drugs also reduce inflammation, but they target your immune system rather than treating inflammation itself. Because immune suppressors can be effective in treating ulcerative colitis, scientists theorize that damage to digestive tissues is caused by your body’s immune response to an invading virus or bacterium or even to your own tissue. By suppressing this response, inflammation is also reduced. Immunosuppressant drugs include: ■

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Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol). Because azathioprine and mercaptopurine act slowly — taking three months or longer to start working — they’re sometimes initially combined with a corticosteroid, but in time, they seem to produce benefits on their own and the steroids can be tapered off.Side effects can include allergic reactions, bone marrow suppression, infections, and inflammation of the liver and pancreas. There also is a small risk of development of cancer with these medications. If you’re taking either of these medications, you’ll need to follow up closely with your doctor and have your blood checked regularly to look for side effects. If you’ve had cancer, discuss this with your doctor before starting these medications. Cyclosporine (Gengraf, Neoral, Sandimmune). This potent drug is normally reserved for people who don’t respond well to other medications or who face possible surgery because of severe ulcerative colitis. In some cases, cyclosporine may be used to delay surgery until you’re strong enough to undergo the procedure. In others, it’s used to control signs and symptoms until less toxic drugs start working. Cyclosporine begins working in one to two weeks, but because it has the potential for severe side effects, including kidney damage, seizures and fatal infections, talk to your doctor about the risks and benefits of treatment. There’s also a small risk of cancer with these medications, so let your doctor know if you’ve previously had cancer. Infliximab (Remicade). This drug is specifically for those with moderate to severe ulcerative

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colitis who don’t respond to or can’t tolerate other treatments. It works quickly to bring on remission, especially for people who haven’t responded well to corticosteroids. This drug can sometimes prevent surgery for some people. It works by neutralizing a protein produced by your immune system known as tumor necrosis factor (TNF). Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract.Some people with heart failure, people with multiple sclerosis, and people with cancer or a history of cancer can’t take infliximab. The drug has been linked to an increased risk of infection, especially tuberculosis and reactivation of viral hepatitis, and may increase your risk of blood problems and cancer. You’ll need to have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B before taking infliximab.Also, because infliximab contains mouse protein, it can cause serious allergic reactions in some people — reactions that may be delayed for days to weeks after starting treatment. Once started, infliximab is generally continued as long-term therapy, although its effectiveness may decrease over time. Adalimumab (Humira) is an alternative to inflixmab for people whose ulcerative colitis has not been helped by other medications such as azathioprine or 6 mercaptopurine. It may also be considered for people who initially improve with infliximab but then improvement stops; but its benefit in this situation remains unproven. Adalimumab, like infliximab, carries a small risk of infections, including tuberculosis and serious fungal infections. Before taking adalimumab, you should have a skin test for tuberculosis, a chest X-ray and a test for hepatitis B. The most common side effects of adalimumab are skin irritation and pain at the injection site, nausea, runny nose and upper respiratory infection.

Other medications In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your ulcerative colitis, your doctor may recommend one or more of the following: ■

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Antibiotics. People with ulcerative colitis who run fevers will likely be given antibiotics to help prevent or control infection. Anti-diarrheals. For severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheal medications with great caution, however, because they increase the risk of toxic megacolon. Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). Don’t use ibuprofen (Advil, Motrin, others), naproxen (Aleve) or aspirin. These are likely to make your symptoms worse. Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of anemia once your bleeding has stopped or diminished.

Surgery If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your signs and symptoms, your doctor may recommend surgery. Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy). In the past, after this surgery you would wear a small bag over an opening in your abdomen (ileal stoma) to collect stool. But a procedure called ileoanal anastomosis

eliminates the need to wear a bag. Instead, your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus. This allows you to expel waste more normally, although you may have more-frequent bowel movements that are soft or watery because you no longer have your colon to absorb water.

Pregnancy Women with ulcerative colitis can usually have successful pregnancies, especially if they can keep the disease in remission during pregnancy. Ideally, you’ll become pregnant when your disease is in remission. Some medications may not be indicated for use in pregnancy, especially during the first trimester, and the effects of certain medications may linger after you stop them. Talk with your doctor about the best way to manage your illness before you conceive. If you stop certain medications, their effects may linger. It’s estimated that the risk of passing ulcerative colitis to your unborn child if your partner doesn’t have ulcerative colitis is less than 10 percent.

Cancer surveillance Screening for colon cancer often needs to be done more frequently because people who have ulcerative colitis have an increased risk of colon cancer. It’s recommended that people with pancolitis begin colon cancer screening with a colonoscopy eight years after diagnosis. For those who have left-sided colitis, screening with colonoscopy is recommended beginning 10 years after diagnosis. People with proctitis can follow the usual colon cancer screening guidelines that call for a colonoscopy every 10 years beginning at age 50.

Lifestyle and home remedies Sometimes you may feel helpless when facing ulcerative colitis. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

Diet There’s no firm evidence that what you eat causes inflammatory bowel disease. But certain foods and beverages can aggravate your symptoms, especially during a flare-up in your condition. It’s a good idea to try eliminating from your diet anything that seems to make your signs and symptoms worse. Here are some suggestions that may help: ■

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Limit dairy products. If you suspect that you may be lactose intolerant, you may find that diarrhea, abdominal pain and gas improve when you limit or eliminate dairy products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. If so, try using an enzyme product, such as Lactaid, to help break down lactose. If you need help, a registered dietitian can help you design a healthy diet that’s low in lactose. Keep in mind that with limiting your dairy intake, you’ll need to find other sources of calcium, such as supplements. Experiment with fiber. For most people, high-fiber foods, such as fresh fruits and vegetables and whole grains, are the foundation of a healthy diet. But if you have inflammatory bowel disease, fiber may make diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. Check with your doctor before adding significant amounts of fiber to your diet. Avoid problem foods. Eliminate any other foods that seem to make your symptoms worse. These

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may include “gassy” foods, such as beans, cabbage and broccoli, raw fruit juices and fruits, popcorn, caffeine, and carbonated beverages. Eat small meals. You may find that you feel better eating five or six small meals rather than two or three larger ones. Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas. Ask about multivitamins. Because ulcerative colitis can interfere with your ability to absorb nutrients and because your diet may be limited, vitamin and mineral supplements can play a key role in supplying missing nutrients. They don’t provide essential protein and calories, however, and shouldn’t be a substitute for meals. Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Stress Although stress doesn’t cause inflammatory bowel disease, it can make your signs and symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one. When you’re stressed, your normal digestive process can change, causing your stomach to empty more slowly and secrete more acids. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself. Although it’s not always possible to avoid stress, you can learn ways to help manage it. Some of these include: ■

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Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that’s right for you. Biofeedback. This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the help of a feedback machine. You’re then taught how to produce these changes yourself. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers. Regular relaxation and breathing exercises. An effective way to cope with stress is to perform relaxation and breathing exercises. You can take classes in yoga and meditation or practice at home using books, CDs or DVDs. Hypnosis. Hypnosis may reduce abdominal pain and bloating. A trained professional can teach you how to enter a relaxed state. Other techniques. Set aside time every day for activities you find relaxing — listening to music, reading, playing computer games or just soaking in a warm bath.

Alternative medicine Many people with inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease, have used some form of alternative or complementary therapy. Side effects and ineffectiveness of conventional therapies may be among the reasons for seeking alternative care.

These therapies generally aren’t regulated by the Food and Drug Administration. Manufacturers can claim that their therapies are safe and effective, but don’t need to prove it. Because even natural herbs can have side effects and cause dangerous interactions, talk to your doctor before trying any alternative or complementary therapies. Currently, no alternative therapies have good evidence supporting their use in treating ulcerative colitis, but some that may eventually prove beneficial include: ■

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Probiotics. Because bacteria in the intestine have been implicated in ulcerative colitis, researchers suspect that adding more of the beneficial bacteria (probiotics) that are normally found in the digestive tract might help combat the disease. Fish oil. Fish oil acts as an anti-inflammatory, but studies on its possible benefits for people with ulcerative colitis have had conflicting results. Aloe vera. Aloe vera juice has been purported to have an anti-inflammatory effect for people with ulcerative colitis, but there’s no strong evidence to back this claim. In addition, when ingested, aloe vera can have a laxative effect. Acupuncture. Several studies have found acupuncture to be of benefit to people with ulcerative colitis. The procedure involves the insertion of fine needles into the skin, which may stimulate the release of the body’s natural painkillers. Tumeric. Curcumin, a compound found in the spice turmeric, has been combined with standard ulcerative colitis therapies, such as corticosteroids or sulfasalazine, in clinical trials. This combination helped improve symptoms and allowed smaller doses of the standard drugs to be used. This evidence comes from two small studies, however. More research is needed before this treatment can be recommended.

If you decide to try an alternative therapy, be sure to tell your doctor so that he or she can let you know about any potential interactions. You can also find out if a particular therapy has been studied in reputable trials by calling the National Center for Complementary and Alternative Medicine at 888-644-6226 or by looking on its website.

Irritable bowel syndrome Irritable bowel syndrome (IBS) is a common disorder that affects your large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating gas, diarrhea and constipation. Despite these uncomfortable signs and symptoms, IBS doesn’t cause permanent damage to your colon. Most people with IBS find that symptoms improve as they learn to control their condition. Only a small number of people with irritable bowel syndrome have disabling signs and symptoms. Fortunately, unlike more-serious intestinal diseases such as ulcerative colitis and Crohn’s disease, irritable bowel syndrome doesn’t cause inflammation or changes in bowel tissue or increase your risk of colorectal cancer. In many cases, you can control irritable bowel syndrome by managing your diet, lifestyle and stress.

What are the symptoms of Irritable bowel syndrome? The signs and symptoms of irritable bowel syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are: ■

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Abdominal pain or cramping A bloated feeling Gas (flatulence) Diarrhea or constipation — sometimes even alternating bouts of constipation and diarrhea Mucus in the stool

Like many people, you may have only mild signs and symptoms of irritable bowel syndrome. However, sometimes these problems can be disabling. In some cases, you may have severe signs and symptoms that don’t respond well to medical treatment. Because symptoms of irritable bowel syndrome can occur with other more serious diseases, it’s best to discuss these symptoms with your doctor. For most people, IBS is a chronic condition, although there will likely be times when the signs and symptoms are worse and times when they improve or even disappear completely.

When to see a doctor It’s important to see your doctor if you have a persistent change in bowel habits or if you have any other signs or symptoms of IBS. These may indicate a more serious condition, such as an infection or colon cancer. Your doctor may be able to help you find ways to relieve symptoms as well as rule out other moreserious colon conditions, such as ulcerative colitis and Crohn’s disease, which are forms of inflammatory bowel disease.

What are the causes of Irritable bowel syndrome? It’s not known exactly what causes irritable bowel syndrome. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have irritable bowel syndrome, the contractions may be stronger and last longer than normal. Food is forced through your intestines more quickly, causing gas, bloating and diarrhea. In some cases, the opposite occurs. Food passage slows, and stools become hard and dry. Abnormalities in your nervous system or colon also may play a role, causing you to experience greater than normal discomfort when your intestinal wall stretches from gas. There are a number of other factors that may play a role in IBS. For example, people with IBS may have abnormal serotonin levels. Serotonin is a chemical messenger that’s normally associated with brain function, but it also plays a role in normal digestive system function. It’s also possible that people with IBS don’t have the right balance of good bacteria in the intestine.

Triggers affect some people, not others For reasons that still aren’t clear, if you have IBS you probably react strongly to stimuli that don’t

bother other people. Triggers for IBS can range from gas or pressure on your intestines to certain foods, medications or emotions. For example: ■

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Foods. Many people find that their signs and symptoms worsen when they eat certain foods. For instance, chocolate, milk and alcohol might cause constipation or diarrhea. Carbonated beverages and some fruits and vegetables may lead to bloating and discomfort in some people with IBS. The role of food allergy or intolerance in irritable bowel syndrome has yet to be clearly understood.If you experience cramping and bloating mainly after eating dairy products, food with caffeine, or sugar-free gum or candies, the problem may not be irritable bowel syndrome. Instead, your body may not be able to tolerate the sugar (lactose) in dairy products, caffeine or the artificial sweetener sorbitol. Stress. If you’re like most people with IBS, you probably find that your signs and symptoms are worse or more frequent during stressful events, such as a change in your daily routine. But while stress may aggravate symptoms, it doesn’t cause them. Hormones. Because women are more likely to have IBS, researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods.

What is the risk factor? Many people have occasional signs and symptoms of irritable bowel syndrome. However, you’re more likely to have IBS if you: ■

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Are young. IBS symptoms first appear before the age of 35 for about half of those with the disorder. Are female. More women than men are diagnosed with this condition. Have a family history of IBS. Studies have shown that people who have a first-degree relative — such as a parent or sibling — with IBS are at increased risk of the condition. It’s not clear whether the influence of family history on IBS risk is related to genes, to shared factors in a family’s environment, or both.

What complications you could have? IBS isn’t associated with any serious conditions, such as colon cancer. But, diarrhea and constipation, both signs of irritable bowel syndrome, can aggravate or even cause hemorrhoids. The impact of IBS on your overall quality of life may be its most significant complication. IBS might limit your ability to: ■

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Make or keep plans with friends and family. If you have IBS, the difficulty of coping with symptoms away from home may cause you to avoid social engagements. Enjoy a healthy sex life. The physical discomfort of IBS may make sexual activity unappealing or even painful.

These effects of IBS may cause you to feel you’re not living life to the fullest, leading to discouragement or even depression.

Tests and diagnosis A diagnosis of irritable bowel syndrome depends largely on a complete medical history and physical exam.

Criteria for making a diagnosis Because there are usually no physical signs to definitively diagnose irritable bowel syndrome, diagnosis is often a process of elimination. To help in this process, researchers have developed diagnostic criteria, known as Rome criteria, for IBS and other functional gastrointestinal disorders. These are conditions in which the bowel appears normal, but doesn’t function normally. According to these criteria, you must have certain signs and symptoms before a doctor diagnoses irritable bowel syndrome. The most important symptom is: ■

Abdominal pain and discomfort lasting at least 12 weeks, though the weeks don’t have to occur consecutively

You also must have at least two of the following: ■

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A change in the frequency or consistency of your stool — for example, you may change from having one normal, formed stool every day to three or more loose stools daily, or you may have only one hard stool every few days Straining, urgency or a feeling that you can’t empty your bowels completely Mucus in your stool Bloating or abdominal distension

Your doctor will likely assess how you fit these criteria, as well as whether you have any other signs or symptoms that might suggest another, more-serious condition. Some red flag signs and symptoms that might prompt your doctor to do additional testing include: ■

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New onset after age 50 Weight loss Rectal bleeding Fever Nausea or recurrent vomiting Abdominal pain, especially if it’s not completely relieved by a bowel movement Diarrhea that is persistent or awakens you from sleep

If you have these red flag signs or symptoms, you’ll need additional testing to further assess your condition. If you fit the IBS criteria and don’t have any red flag signs or symptoms, your doctor may suggest a course of treatment without doing additional testing. But if you don’t respond to that treatment, you’ll likely require more tests.

Additional tests Your doctor may recommend several tests, including stool studies to check for infection or

malabsorption problems. Among the tests that you may undergo to rule out other causes for your symptoms are the following: ■

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Flexible sigmoidoscopy. This test examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope). Colonoscopy. In some cases, your doctor may perform this diagnostic test, in which a small, flexible tube is used to examine the entire length of the colon. Computerized tomography (CT) scan. CT scans produce cross-sectional X-ray images of internal organs. CT scans of your abdomen and pelvis may help your doctor rule out other causes of your symptoms. Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar (lactose) found in dairy products. If you don’t produce this enzyme, you may have problems similar to those caused by irritable bowel syndrome, including abdominal pain, gas and diarrhea. To find out if this is the cause of your symptoms, your doctor may order a breath test or ask you to exclude milk and milk products from your diet for several weeks. Blood tests. Celiac disease (nontropical sprue) is sensitivity to wheat protein that also may cause signs and symptoms like those of irritable bowel syndrome. Blood tests may help rule out that disorder.

Treatments and drugs Because it’s not clear what causes irritable bowel syndrome, treatment focuses on the relief of symptoms so that you can live as normally as possible. In most cases, you can successfully control mild signs and symptoms of irritable bowel syndrome by learning to manage stress and making changes in your diet and lifestyle. But if your problems are moderate or severe, you may need to do more. Your doctor may suggest: ■

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Fiber supplements. Taking fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), with fluids may help control constipation. Anti-diarrheal medications. Over-the-counter medications, such as loperamide (Imodium), can help control diarrhea. Eliminating high-gas foods. If you have bothersome bloating or are passing considerable amounts of gas, your doctor may suggest that you avoid such items as carbonated beverages, salads, raw fruits and vegetables — especially cabbage, broccoli and cauliflower. Anticholinergic medications. Some people need medications that affect certain activities of the autonomic nervous system (anticholinergics) to relieve painful bowel spasms. These may be helpful for people who have bouts of diarrhea, but can worsen constipation. Antidepressant medications. If your symptoms include pain or depression, your doctor may recommend a tricyclic antidepressant or a selective serotonin reuptake inhibitor (SSRI). These medications help relieve depression as well as inhibit the activity of neurons that control the intestines. If you have diarrhea and abdominal pain without depression, your doctor may suggest a lower than usual dose of tricyclic antidepressants, such as imipramine (Tofranil) and amitriptyline. Side effects of these drugs include drowsiness and constipation. SSRIs, such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil), may be helpful if you’re depressed and have pain and constipation. These medications can worsen diarrhea, however.

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Antibiotics. It’s unclear what role, if any, antibiotics might play in treating IBS. Some people whose symptoms are due to an overgrowth of bacteria in their intestines may benefit from antibiotic treatment. But more research is needed. Counseling. If antidepressant medications don’t work, you may have better results from counseling if stress tends to worsen your symptoms.

Medication specifically for IBS Two medications are currently approved for specific cases of IBS: ■

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Alosetron (Lotronex). Alosetron is a nerve receptor antagonist that’s designed to relax the colon and slow the movement of waste through the lower bowel. The drug was removed from the market soon after its original approval because it was linked to serious complications. The Food and Drug Administration (FDA) has since allowed alosetron to be used again — with restrictions. The drug can be prescribed only by doctors enrolled in a special program and is intended for severe cases of diarrhea-predominant IBS in women who haven’t responded to other treatments. Alosetron is not approved for use by men.Generally, alosetron should only be used if usual therapy for IBS has failed. Additionally, it should only be prescribed by a gastroenterologist with expertise in IBS because of the potential side effects. Lubiprostone (Amitiza). Lubiprostone is approved for adult women and men who have IBS with constipation. Lubiprostone is a chloride channel activator that you take twice a day. It works by increasing fluid secretion in your small intestine to help with the passage of stool. Common side effects include nausea, diarrhea and abdominal pain. More research is needed to fully understand the effectiveness and safety of lubiprostone. Currently, the drug is generally prescribed only for those with IBS and severe constipation for whom other treatments have failed.

Lifestyle and home remedies In many cases, simple changes in your diet and lifestyle can provide relief from irritable bowel syndrome. Although your body may not respond immediately to these changes, your goal is to find long-term, not temporary, solutions: ■

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Incorporate fiber into your diet, if possible. When you have irritable bowel syndrome, dietary fiber can have mixed results. Although it helps reduce constipation, it can also make gas and cramping worse. The best approach is to gradually increase the amount of fiber in your diet over a period of weeks. Examples of foods that contain fiber are whole grains, fruits, vegetables and beans. If your signs and symptoms remain the same or worse, tell your doctor. You may also want to talk to a dietitian.Some people do better limiting dietary fiber and instead take a fiber supplement that causes less gas and bloating. If you take a fiber supplement, such as Metamucil or Citrucel, be sure to introduce it gradually and drink plenty of water every day to minimize gas, bloating and constipation. If you find that taking fiber helps your IBS, use it on a regular basis for best results. Avoid problem foods. If certain foods make your signs and symptoms worse, don’t eat them. Common culprits include alcohol, chocolate, caffeinated beverages such as coffee and sodas, medications that contain caffeine, dairy products, and sugar-free sweeteners such as sorbitol or mannitol. If gas is a problem for you, foods that might make symptoms worse include beans,

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cabbage, cauliflower and broccoli. Fatty foods may also be a problem for some people. Chewing gum or drinking through a straw can both lead to swallowing air, causing more gas. Eat smaller meals. If you have diarrhea, you may find that eating small, frequent meals makes you feel better. Take care with dairy products. If you’re lactose intolerant, try substituting yogurt for milk. Or use an enzyme product to help break down lactose. Consuming small amounts of milk products or combining them with other foods also may help. In some cases, though, you may need to eliminate dairy foods completely. If so, be sure to get enough protein and calcium from other sources. A dietitian can help you analyze what you’re eating to make sure you’re getting adequate nutrition. Drink plenty of liquids. Try to drink plenty of fluids every day. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, and carbonated drinks can produce gas. Exercise regularly. Exercise helps relieve depression and stress, stimulates normal contractions of your intestines and can help you feel better about yourself. If you’ve been inactive, start slowly and gradually increase the amount of time you exercise. If you have other medical problems, check with your doctor before starting an exercise program. Use anti-diarrheal medications and laxatives with caution.If you try over-the-counter antidiarrheal medications, such as Imodium or Kaopectate, use the lowest dose that helps. Imodium may be helpful if taken 20 to 30 minutes before eating, especially if the food planned for your meal is likely to cause diarrhea. In the long run, these medications can cause problems if you don’t use them appropriately. The same is true of laxatives. If you have any questions about them, check with your doctor or pharmacist.

Alternative medicine The following nontraditional therapies may help relieve symptoms of irritable bowel syndrome: ■

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Acupuncture. Although study results on the effects of acupuncture on symptoms of irritable bowel syndrome have been mixed, some people use acupuncture to help relax muscle spasms and improve bowel function. Herbs. Peppermint is a natural antispasmodic that relaxes smooth muscles in the intestines. Peppermint may provide short-term relief of IBS symptoms, but study results have been inconsistent. If you’d like to try peppermint, be sure to use enteric-coated capsules. Peppermint may aggravate heartburn. Before taking any herbs, check with your doctor to be sure they won’t interact or interfere with other medications you may be taking. Hypnosis. Hypnosis may reduce abdominal pain and bloating. A trained professional teaches you how to enter a relaxed state and then guides you in relaxing your abdominal muscles. Probiotics. Probiotics are “good” bacteria that normally live in your intestines and are found in certain foods, such as yogurt, and in dietary supplements. It’s been suggested that people with irritable bowel syndrome may not have enough good bacteria, and that adding probiotics to the diet may help ease symptoms. Some studies have found that probiotics may relieve symptoms of IBS, such as abdominal pain and bloating, but more research is needed. Regular exercise, yoga, massage or meditation. These can all be effective ways to relieve stress. You can take classes in yoga and meditation or practice at home using books or videos.

Iron deficiency anemia Iron deficiency anemia is a common type of anemia — a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body’s tissues. As the name implies, iron deficiency anemia is due to insufficient iron. Without enough iron, your body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, iron deficiency anemia may leave you tired and short of breath. You can usually correct iron deficiency anemia with iron supplementation. Sometimes additional tests or treatments for iron deficiency anemia are necessary, especially if your doctor suspects that you’re bleeding internally.

What are the symptoms of Iron deficiency anemia? Initially, iron deficiency anemia can be so mild that it goes unnoticed. But as the body becomes more deficient in iron and anemia worsens, the signs and symptoms intensify. Iron deficiency anemia symptoms may include: ■

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Extreme fatigue Pale skin Weakness Shortness of breath Chest pain Frequent infections Headache Dizziness or lightheadedness Cold hands and feet Inflammation or soreness of your tongue Brittle nails Fast heartbeat Unusual cravings for non-nutritive substances, such as ice, dirt or starch Poor appetite, especially in infants and children with iron deficiency anemia An uncomfortable tingling or crawling feeling in your legs (restless legs syndrome)

When to see a doctor If you or your child develops signs and symptoms that suggest iron deficiency anemia, see your doctor. Iron deficiency anemia isn’t something to self-diagnose or treat. So see your doctor for a diagnosis rather than taking iron supplements on your own. Overloading the body with iron can be dangerous because excess iron accumulation can damage your liver and cause other complications.

What are the causes of Iron deficiency anemia? Iron deficiency anemia occurs when your body doesn’t have enough iron to produce hemoglobin.

Hemoglobin is the part of red blood cells that gives blood its red color and enables the red blood cells to carry oxygenated blood throughout your body. If you aren’t consuming enough iron, or if you’re losing too much iron, your body can’t produce enough hemoglobin, and iron deficiency anemia will eventually develop. Causes of iron deficiency anemia include: ■

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Blood loss. Blood contains iron within red blood cells. So if you lose blood, you lose some iron. Women with heavy periods are at risk of iron deficiency anemia because they lose blood during menstruation. Slow, chronic blood loss within the body — such as from a peptic ulcer, a hiatal hernia, a colon polyp or colorectal cancer — can cause iron deficiency anemia. Gastrointestinal bleeding can result from regular use of some over-the-counter pain relievers, especially aspirin. A lack of iron in your diet. Your body regularly gets iron from the foods you eat. If you consume too little iron, over time your body can become iron deficient. Examples of iron-rich foods include meat, eggs, leafy green vegetables and iron-fortified foods. For proper growth and development, infants and children need iron from their diet, too. An inability to absorb iron. Iron from food is absorbed into your bloodstream in your small intestine. An intestinal disorder, such as celiac disease, which affects your intestine’s ability to absorb nutrients from digested food, can lead to iron deficiency anemia. If part of your small intestine has been bypassed or removed surgically, that may affect your ability to absorb iron and other nutrients. Pregnancy. Without iron supplementation, iron deficiency anemia occurs in many pregnant women because their iron stores need to serve their own increased blood volume as well as be a source of hemoglobin for the growing fetus.

What is the risk factor? These groups of people may have an increased risk of iron deficiency anemia: ■

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Women. Because women lose blood during menstruation, women in general are at greater risk of iron deficiency anemia. Infants and children. Infants, especially those who were low birth weight or born prematurely, who don’t get enough iron from breast milk or formula may be at risk of iron deficiency. Children need extra iron during growth spurts. If your child isn’t eating a healthy, varied diet, he or she may be at risk of anemia. Vegetarians. People who don’t eat meat may have a greater risk of iron deficiency anemia if they don’t eat other iron-rich foods. Frequent blood donors. People who routinely donate blood may have an increased risk of iron deficiency anemia since blood donation can deplete iron stores. Low hemoglobin related to blood donation may be a temporary problem remedied by eating more iron-rich foods. If you’re told that you can’t donate blood because of low hemoglobin, ask your doctor whether you should be concerned.

What complications could you have? Mild iron deficiency anemia usually doesn’t cause complications. However, left untreated, iron

deficiency anemia can become severe and lead to health problems, including the following: ■

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Heart problems. Iron deficiency anemia may lead to a rapid or irregular heartbeat. Your heart must pump more blood to compensate for the lack of oxygen carried in your blood when you’re anemic. This can lead to an enlarged heart or heart failure. Problems during pregnancy. In pregnant women, severe iron deficiency anemia has been linked to premature births and low birth weight babies. But the condition is preventable in pregnant women who receive iron supplements as part of their prenatal care. Growth problems. In infants and children, severe iron deficiency can lead to anemia as well as delayed growth and development. Additionally, iron deficiency anemia is associated with an increased susceptibility to infections.

Tests and diagnosis To diagnose iron deficiency anemia, your doctor may run tests to look for: ■

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Red blood cell size and color. With iron deficiency anemia, red blood cells are smaller and paler in color than normal. Hematocrit. This is the percentage of your blood volume made up by red blood cells. Normal levels are generally between 34.9 and 44.5 percent for adult women and 38.8 to 50 percent for adult men. These values may change depending on your age. Hemoglobin. Lower than normal hemoglobin levels indicate anemia. The normal hemoglobin range is generally defined as 13.5 to 17.5 grams (g) of hemoglobin per deciliter (dL) of blood for men and 12.0 to 15.5 g/dL for women. The normal ranges for children vary depending on the child’s age and sex. Ferritin. This protein helps store iron in your body, and a low level of ferritin usually indicates a low level of stored iron.

Additional diagnostic tests If your blood work indicates iron deficiency anemia, your doctor may order additional tests to identify an underlying cause, such as: ■

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Endoscopy. Doctors often check for bleeding from a hiatal hernia, an ulcer or the stomach with the aid of endoscopy. In this procedure, a thin, lighted tube equipped with a video camera is passed down your throat to your stomach. This allows your doctor to view your esophagus — the tube that runs from your mouth to your stomach — and your stomach to look for sources of bleeding. Colonoscopy. To rule out lower intestinal sources of bleeding, your doctor may recommend a procedure called colonoscopy. A thin, flexible tube equipped with a video camera is inserted into the rectum and guided to your colon. You’re usually sedated during this test. A colonoscopy allows your doctor to view inside some or all of your colon and rectum to look for internal bleeding. Ultrasound. Women may also have a pelvic ultrasound to look for the cause of excess menstrual bleeding, such as uterine fibroids.

Your doctor may order these or other tests after a trial period of treatment with iron supplementation.

Treatments and drugs To treat iron deficiency anemia, your doctor may recommend you take iron supplements. Your doctor will also treat the underlying cause of your iron deficiency, if necessary.

Iron supplements Your doctor may recommend over-the-counter iron tablets to replenish the iron stores in your body. Your doctor will let you know the correct dose for you. Iron is also available in liquid form for infants and children. To improve the chances that your body will absorb the iron in the tablets, you may be instructed to: ■

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Take iron tablets on an empty stomach. If possible, take your iron tablets when your stomach is empty. However, because iron tablets can upset your stomach, you may need to take your iron tablets with meals. Don’t take iron with antacids. Medications that immediately relieve heartburn symptoms can interfere with the absorption of iron. Take iron two hours before or four hours after you take antacids. Take iron tablets with vitamin C. Vitamin C improves the absorption of iron. Your doctor might recommend taking your iron tablets with a glass of orange juice or with a vitamin C supplement.

Iron supplements can cause constipation, so your doctor may also recommend a stool softener. Iron may turn your stools black, which is a harmless side effect. Iron deficiency can’t be corrected overnight. You may need to take iron supplements for several months or longer to replenish your iron reserves. Generally, you’ll start to feel better after a week or so of treatment. Ask your doctor when you need to return to have your blood rechecked to measure your iron levels. To be sure that your iron reserves are replenished, you’ll probably need to take iron supplements for a year or more.

Treating underlying causes of iron deficiency If iron supplements don’t increase your blood-iron levels, it’s likely the anemia is due to a source of bleeding or an iron-absorption problem that your doctor will need to investigate and treat. Depending on the cause, iron deficiency anemia treatment may involve: ■

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Medications, such as oral contraceptives to lighten heavy menstrual flow Antibiotics and other medications to treat peptic ulcers Surgery to remove a bleeding polyp, a tumor or a fibroid

If iron deficiency anemia is severe, you may need iron given intravenously or you may need blood transfusions to help replace iron and hemoglobin quickly.

Ischemic colitis Ischemic colitis occurs when blood flow to part of the large intestine (colon) is reduced due to narrowed or blocked blood vessels (arteries). The diminished blood flow provides insufficient oxygen

for the cells in your digestive system. It can cause pain and can damage your colon. Ischemic colitis can affect any part of the colon, but most people experience pain on the left side of the belly area (abdomen). Ischemic colitis is most common among people older than age 60. It can be misdiagnosed because it can easily be confused with other digestive problems. Ischemic colitis may heal on its own. But you may need medication to treat or prevent infection, or surgery if your colon has been damaged.

What are the symptoms of Ischemic colitis? Signs and symptoms of ischemic colitis can include: ■

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Pain, tenderness or cramping in your belly, which can occur suddenly or gradually Bright red or maroon-colored blood in your stool or, at times, passage of blood alone without stool A feeling of urgency to move your bowels Diarrhea

The risk of severe complications is higher when you have symptoms on the right side of your abdomen. That’s because the arteries that feed the right side of your colon also feed part of your small intestine. When blood flow is blocked on the right side of your colon, it’s likely that flow is blocked to part of your small intestine as well. Pain tends to be more severe with this type of ischemic colitis. Blocked blood flow to the small intestine can quickly lead to death of intestinal tissue (necrosis). If this life-threatening situation occurs, you’ll need surgery to clear the blockage and to remove the portion of the intestine that has been damaged.

When to see a doctor Seek immediate medical care if you have sudden, severe abdominal pain. Abdominal pain that makes you so uncomfortable that you can’t sit still or find a comfortable position is a medical emergency. Contact your doctor if you develop worrisome signs and symptoms, such as bloody diarrhea. Early diagnosis and treatment can help prevent serious complications.

What are the causes of Ischemic colitis? The precise cause of diminished blood flow to the colon isn’t always clear. But several factors can increase your risk of colon ischemia: ■

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Buildup of fatty deposits on the walls of an artery (atherosclerosis) Dangerously low blood pressure (hypotension) associated with heart failure, major surgery, trauma or shock A blood clot in an artery supplying the colon or, less commonly, in a vein (venous thrombosis) Bowel obstruction caused by a hernia, scar tissue or a tumor Surgery involving the heart or blood vessels, or the digestive or gynecological systems Other medical disorders that affect your blood, such as inflammation of the blood vessels (vasculitis), lupus or sickle cell anemia

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Cocaine or methamphetamine use Colon cancer (rare)

The role of medications Certain medicines also can lead to ischemic colitis, though this is rare. They include: ■

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Nonsteroidal anti-inflammatory drugs Some heart and migraine medications that shrink blood vessels Hormone medications, such as estrogen Antibiotics Pseudoephedrine Certain medications for irritable bowel syndrome Chemotherapy medications

What is the risk factor? Risk factors for ischemic colitis include: ■

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Age. The condition occurs mostly frequently in adults older than age 60. Ischemic colitis that occurs in a young adult may be a sign of a blood-clotting abnormality or inflammation of the blood vessels (vasculitis). High cholesterol, which can lead to atherosclerosis. Certain medical conditions, including previous abdominal surgery, heart failure, low blood pressure and shock. Irritable bowel syndrome (IBS). Ischemic colitis is diagnosed three times more frequently in people with IBS than in people without that disorder. Heavy exercise, such as marathon running, which can lead to reduced blood flow to the colon. Surgery involving the large artery (aorta) that pumps blood from your heart to the rest of your body.

What complications could you have? Ischemic colitis usually gets better on its own within two to three days. In more-severe cases, complications can include: ■

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Tissue death (gangrene) resulting from diminished blood flow Hole (perforation) in your intestine, or persistent bleeding Bowel inflammation (segmented ulcerating colitis) Bowel obstruction (ischemic stricture)

Tests and diagnosis Ischemic colitis can be misdiagnosed because it is often confused with other disorders, especially inflammatory bowel disease (IBD). Based on your signs and symptoms, your doctor may recommend these imaging tests:

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Ultrasound and abdominal CT scans, to provide images of your colon that can be helpful in ruling out other disorders, such as IBD. Stool analysis, to rule out infection as a cause of your symptoms. CT or MR angiography, to provide detailed images of blood flow in your small intestine and to look for blocked arteries. This test is usually used only if ischemia is suspected in your small bowel as well as in your colon.

Rarely, colon cancer can cause ischemic colitis. Your doctor will recommend colonoscopy to check for cancer, usually after the symptoms of ischemic colitis have eased. It’s important to wait for intestinal inflammation to go down because inflammation can hide cancer.

Treatments and drugs Treatment for ischemic colitis depends on the severity of your condition. Signs and symptoms often diminish in two to three days in mild cases. But your doctor may recommend: ■

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Antibiotics, to prevent infections Intravenous fluids, if you are dehydrated Treatment for any underlying medical condition, such as congestive heart failure or an irregular heartbeat Avoiding medications that constrict your blood vessels, such as migraine drugs, hormone medications and some heart drugs

Your doctor will schedule follow-up colonoscopies to monitor healing and look for complications.

Surgery If ischemic colitis is severe or your colon has been damaged, you may need surgery to: ■

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Remove dead tissue Repair a hole in your colon Bypass a blockage in an intestinal artery Remove part of the colon that has narrowed because of scarring, and is causing a blockage

The likelihood of surgery may be higher if you have an underlying condition, such as heart disease or low blood pressure.

Lactose intolerance Lactose intolerance, also called lactase deficiency, means you aren’t able to fully digest the milk sugar (lactose) in dairy products. It’s usually not dangerous, but symptoms of lactose intolerance can be uncomfortable. A deficiency of lactase — an enzyme produced by the lining of your small intestine — is usually responsible for lactose intolerance. Many people have low levels of lactase, but only those who also

have associated signs and symptoms have, by definition, lactose intolerance. You can control symptoms of lactose intolerance by carefully choosing a diet that limits dairy products.

What are the symptoms of Lactose intolerance? The signs and symptoms of lactose intolerance usually begin 30 minutes to two hours after eating or drinking foods that contain lactose. Common signs and symptoms include: ■

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Diarrhea Nausea, and sometimes, vomiting Abdominal cramps Bloating Gas

Symptoms are usually mild, but may sometimes be severe.

When to see a doctor Make an appointment with your doctor if you or your child has any signs or symptoms that worry you.

What are the causes of Lactose intolerance? Lactose intolerance is usually caused by low levels of the enzyme lactase in your small intestine that lead to signs and symptoms. Normally, the cells that line your small intestine produce an enzyme called lactase. The lactase enzyme attaches to lactose molecules in the food you eat and breaks them into two simple sugars — glucose and galactose — which can be absorbed into your bloodstream. Without enough of the lactase enzyme, most of the lactose in your food moves unprocessed into the colon, where the normal intestinal bacteria interact with it. This causes the hallmarks of lactose intolerance — gas, bloating and diarrhea. There are three types of lactose intolerance. Normal result of aging for some people (primary lactose intolerance) Normally, your body produces large amounts of lactase at birth and during early childhood, when milk is the primary source of nutrition. Usually your lactase production decreases as your diet becomes more varied and less reliant on milk. This gradual decline may lead to symptoms of lactose intolerance. Result of illness or injury (secondary lactose intolerance) This form of lactose intolerance occurs when your small intestine decreases lactase production after an illness, surgery or injury to your small intestine. It can occur as a result of intestinal diseases, such as celiac disease, gastroenteritis and an inflammatory bowel disease like Crohn’s disease. Treatment of the underlying disorder may restore lactase levels and improve signs and symptoms, though it can take time.

Condition you’re born with (congenital lactose intolerance) It’s possible, but rare, for babies to be born with lactose intolerance caused by a complete absence of lactase activity. This disorder is passed from generation to generation in a pattern of inheritance called autosomal recessive. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. Infants with congenital lactose intolerance are intolerant of the lactose in their mothers’ breast milk and have diarrhea from birth. These babies require lactose-free infant formulas. Premature infants may also have lactose intolerance because of an insufficient lactase level. In babies who are otherwise healthy, this doesn’t lead to malnutrition.

What is the risk factor? Factors that can make you or your child more prone to lactose intolerance include: ■

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Increasing age. Lactose intolerance becomes more common as you age — the condition is uncommon in babies and young children. Ethnicity. Lactose intolerance is most common in black, Asian, Hispanic and American Indian people. Premature birth. Infants born prematurely may have reduced levels of lactase because this enzyme increases in the fetus late in the third trimester. Diseases affecting the small intestine. Small intestine problems that can cause lactose intolerance include bacterial overgrowth, celiac disease and Crohn’s disease. Certain cancer treatments. If you have received radiation therapy for cancer in your abdomen or have intestinal complications from chemotherapy, you have an increased risk of lactose intolerance.

Tests and diagnosis Your doctor may suspect lactose intolerance based on your symptoms and your response to reducing the amount of dairy foods in your diet. Your doctor can confirm the diagnosis by conducting one or more of the following tests: ■

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Lactose tolerance test. The lactose tolerance test gauges your body’s reaction to a liquid that contains high levels of lactose. Two hours after drinking the liquid, you’ll undergo blood tests to measure the amount of glucose in your bloodstream. If your glucose level doesn’t rise, it means your body isn’t properly digesting and absorbing the lactose-filled drink. Hydrogen breath test. This test also requires you to drink a liquid that contains high levels of lactose. Then your doctor measures the amount of hydrogen in your breath at regular intervals. Normally, very little hydrogen is detectable. However, if your body doesn’t digest the lactose, it will ferment in the colon, releasing hydrogen and other gases, which are absorbed by your intestines and eventually exhaled. Larger than normal amounts of exhaled hydrogen measured during a breath test indicate that you aren’t fully digesting and absorbing lactose. Stool acidity test. For infants and children who can’t undergo other tests, a stool acidity test may be used. The fermenting of undigested lactose creates lactic acid and other acids that can be detected in a stool sample.

Treatments and drugs No treatments can cure lactose intolerance. There’s currently no way to boost your body’s production of the lactase enzyme. People with lactose intolerance usually find relief by reducing the amount of dairy products they eat and using special products made for people with this condition.

Lifestyle and home remedies

Eat fewer dairy products People with lactose intolerance can reduce their signs and symptoms by eating fewer dairy products. For many, dairy products are a convenient way to get vitamins and nutrients, such as calcium. Giving up dairy products doesn’t mean you can’t get enough calcium. Calcium is found in many other foods, such as: ■

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Broccoli Calcium-fortified products, such as breads and juices Canned salmon Milk substitutes, such as soy milk and rice milk Oranges Pinto beans Rhubarb Spinach

If you forgo all dairy products, it’s also important to make sure you get enough vitamin D. There aren’t too many foods with significant amounts of vitamin D, but eggs, liver and yogurt contain vitamin D. Your body also makes vitamin D when exposed to the sun. But, this doesn’t happen when you’re wearing sunscreen, which is necessary for protecting your skin from skin cancer. Ask your doctor for a referral to a dietitian who can help you plan your meals. And, ask your doctor if you need to take calcium or vitamin D supplements.

Use caution if you choose to eat dairy products It may not be necessary to completely avoid dairy foods. Most people with lactose intolerance can enjoy some milk products without symptoms. You may be able to tolerate low-fat milk products, such as skim milk, better than whole-milk products. It also may be possible to increase your tolerance to dairy products by gradually introducing them into your diet. Ways to change your diet to minimize symptoms of lactose intolerance include: ■

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Choosing smaller servings of dairy. Sip small servings of milk — up to 4 ounces (118 milliliters) at a time. The smaller the serving, the less likely it is to cause gastrointestinal problems. Saving milk for mealtimes. Drink milk with other foods. This slows the digestive process and may lessen symptoms of lactose intolerance. Experimenting with an assortment of dairy products. Not all dairy products have the same amount of lactose. For example, hard cheeses, such as Swiss or cheddar, have small amounts of

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lactose and generally cause no symptoms. You may be able to tolerate cultured milk products, such as yogurt, because the bacteria used in the culturing process naturally produce the enzyme that breaks down lactose. Buying lactose-reduced or lactose-free products. You can find these products at most supermarkets in the refrigerated dairy section. Watching out for hidden lactose. Milk and lactose are often added to prepared foods, such as cereal, instant soups, salad dressings, nondairy creamers, processed meats and baking mixes. Check nutrition labels for milk and lactose in the ingredient list. Also look for other words that indicate lactose, such as whey, milk byproducts, fat-free dry milk powder and dry milk solids. Lactose is also used in medications. Tell your pharmacist if you have lactose intolerance. Using lactase enzyme tablets or drops. Over-the-counter tablets or drops containing the lactase enzyme (Dairy Ease, Lactaid, others) may help you digest dairy products. You can take tablets just before a meal or snack. Or the drops can be added to a carton of milk. Not everyone with lactose intolerance is helped by these products.

Alternative medicine

Probiotics Probiotics are living organisms present in your intestines that help maintain a healthy digestive system. Probiotics are also available as active or “live” cultures in some yogurts and as supplements in capsule form. They are sometimes used for gastrointestinal conditions, such as diarrhea and irritable bowel syndrome. They may also help your body digest lactose. Probiotics are generally considered safe and may be worth a try if other methods don’t help.

Microscopic colitis Microscopic colitis is an inflammation of the large intestine (colon) that causes persistent watery diarrhea. The disorder gets its name from the fact that it’s necessary to examine colon tissue under a microscope to identify it. There are two types of microscopic colitis: ■

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Collagenous colitis, in which a thick layer of protein (collagen) develops in colon tissue Lymphocytic colitis, in which white blood cells (lymphocytes) increase in colon tissue

It isn’t known whether collagenous (kuh-LAYJ-uh-nus) colitis and lymphocytic colitis are two separate disorders or represent different phases of the same condition. However, symptoms of collagenous colitis and lymphocytic colitis are similar, as are testing and treatment. The symptoms of microscopic colitis can come and go frequently. Sometimes the symptoms resolve on their own. If not, your doctor can suggest a number of effective medications.

What are the symptoms of Microscopic colitis? Signs and symptoms of microscopic colitis include: ■

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Chronic watery diarrhea Abdominal pain or cramps Weight loss Nausea Fecal incontinence

When to see a doctor If you have watery diarrhea that lasts more than a few days, contact your doctor so that your condition can be diagnosed and properly treated.

What are the causes of Microscopic colitis? It’s not clear what causes the inflammation of the colon found in microscopic colitis. Researchers believe that the causes may include: ■

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Medications that can irritate the lining of the colon Bacteria that produce toxins that irritate the lining of the colon Viruses that trigger inflammation Immune system problems, such as rheumatoid arthritis or celiac disease, that occur when your body’s immune system attacks healthy tissues

What is the risk factor? Risk factors for microscopic colitis include: ■

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Age and gender. Microscopic colitis is most common in people ages 50 to 70 and more common in women than men. Immune system problems. People with microscopic colitis sometimes also have an autoimmune disorder, such as celiac disease, thyroid disease or rheumatoid arthritis. Smoking. Recent research studies have shown an association between tobacco smoking and microscopic colitis, especially in people ages 16 to 44.

Some research studies indicate that using certain medications may increase your risk of microscopic colitis. But not all studies agree. Medications linked to the condition include: ■

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Aspirin, acetaminophen (Tylenol, others), and ibuprofen (Advil, Motrin IB, others) Proton pump inhibitors, including lansoprazole Acarbose (Precose) Flutamide Ranitidine (Zantac) Selective serotonin reuptake inhibitors, such as sertraline (Zoloft) Carbamazepine

It’s not clear why some people who use these medications develop microscopic colitis while others

don’t.

Tests and diagnosis A complete medical history and physical examination can help determine whether other conditions may be contributing to your diarrhea, including: ■

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Celiac disease Autoimmune disorders, such as rheumatoid arthritis

Your doctor will ask about any medications you are taking, particularly aspirin and ibuprofen, which may increase your risk of microscopic colitis. Tests used to diagnose microscopic colitis may include: ■

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Stool sample analysis to help rule out infection as the cause of persistent diarrhea. Blood test or upper endoscopy with biopsy to rule out celiac disease. In endoscopy, a long, thin tube with a camera on the end is used to examine the upper part of your digestive tract. A tissue sample (biopsy) may be removed for analysis in the laboratory. Colonoscopy or flexible sigmoidoscopy with biopsy to help rule out other intestinal disorders. Both tests use a long, thin tube with a camera on the end to examine the inside of your colon. The colons of people with microscopic colitis appear normal. A biopsy can be obtained during colonoscopy or flexible sigmoidoscopy and analyzed for signs of microscopic colitis.

Treatments and drugs Microscopic colitis may get better on its own without treatment. But when symptoms persist or are severe, treatment may be necessary to relieve them. Doctors usually try a stepwise approach, starting with the simplest, most easily tolerated treatments.

Diet and medication changes Treatment usually begins with changes to your diet and medications that may help relieve persistent diarrhea. Your doctor may recommend that you: ■

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Eat a low-fat, low-fiber diet. Foods that contain less fat and are low in fiber may help relieve diarrhea. Discontinue any medication that might be a cause of your symptoms. Your doctor may recommend a different medication to treat an underlying condition.

Medications If signs and symptoms persist, your doctor may recommend: ■

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Anti-diarrhea medications Medications that block bile acids, which can contribute to diarrhea Steroid or anti-inflammatory medications to help control colon inflammation Medications that suppress the immune system to help reduce inflammation in the colon

Surgery When the symptoms of microscopic colitis are severe, and medications aren’t effective, your doctor may recommend surgery to remove all or part of your colon. Surgery is a rare treatment for microscopic colitis. It is imperative that other causes of diarrhea be excluded before surgery is considered.

Lifestyle and home remedies Changes to your diet may help relieve diarrhea that you experience with microscopic colitis. Try to: ■

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Drink plenty of fluids. Water is best, but fluids with added sodium and potassium (electrolytes) may help as well. Try drinking broth or watered-down fruit juice. Avoid beverages that are high in sugar or contain alcohol or caffeine, such as coffee, tea and colas, which may aggravate your symptoms. Choose soft, easy-to-digest foods. These include applesauce, bananas and rice. Avoid high-fiber foods such as beans, nuts and vegetables. If you feel as though your symptoms are improving, slowly add high-fiber foods back to your diet. Eat several small meals rather than a few large meals.Spacing meals throughout the day may ease diarrhea. Avoid irritating foods. Stay away from spicy, fatty or fried foods and any other foods that make your symptoms worse.

Traveler’s diarrhea Traveler’s diarrhea is a digestive tract disorder that commonly causes loose stools and abdominal cramps. It’s caused by eating contaminated food or drinking contaminated water. Fortunately, traveler’s diarrhea usually isn’t serious — it’s just unpleasant. When you visit a place where the climate, social conditions, or sanitary standards and practices are different from yours at home, you have an increased risk of developing traveler’s diarrhea. Being careful about what you eat and drink while traveling can reduce your risk of traveler’s diarrhea. If you do develop traveler’s diarrhea, chances are it will resolve without treatment. However, it’s a good idea to have doctor-approved medications with you when you travel to high-risk areas in case diarrhea persists.

What are the symptoms of Traveler's diarrhoea? Traveler’s diarrhea usually begins abruptly during your trip or shortly after you return home. Most cases improve within one to two days without treatment and clear up completely within a week. However, you can have multiple episodes of traveler’s diarrhea during one trip. The most common signs and symptoms of traveler’s diarrhea are: ■

Abrupt onset of passage of three or more loose stools a day

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An urgent need to defecate Abdominal cramps Nausea Vomiting Fever

Sometimes, people experience moderate to severe dehydration, persistent vomiting, a high fever, bloody stools, or severe pain in the abdomen or rectum. If you or your child experiences any of these signs or symptoms or if the diarrhea lasts longer than a few days, it’s time to see a doctor.

When to see a doctor Traveler’s diarrhea usually goes away on its own within several days. Signs and symptoms may last longer and be more severe if the condition is caused by organisms other than common bacteria. In such cases, you may need prescription medications to help you get better. If you have severe dehydration, persistent vomiting, bloody stools or a high fever, or if your symptoms last for more than a few days, seek medical help. The local embassy or consulate may help you find a well-regarded medical professional who speaks your language. Be especially cautious with children because traveler’s diarrhea can cause severe dehydration in a short time. Call a doctor if your child is sick and exhibits any of the following signs or symptoms: ■

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Persistent vomiting Bloody stools or severe diarrhea A fever of 102 F (39 C) or more Dry mouth or crying without tears Signs of being unusually sleepy, drowsy or unresponsive Decreased volume of urine, including fewer wet diapers in infants

What are the causes of Traveler's diarrhoea? It’s possible that traveler’s diarrhea may stem from the stress of traveling or a change in diet. But almost always an infectious agent is to blame. You typically develop traveler’s diarrhea after ingesting food or water that’s contaminated with organisms from feces. These organisms are infectious agents — including various bacteria, viruses and parasites — that enter your digestive tract and overpower your defense mechanisms, resulting in signs and symptoms of traveler’s diarrhea. The most common cause of traveler’s diarrhea is enterotoxigenic Escherichia coli (ETEC) bacteria. These bacteria attach themselves to the lining of your intestine and release a toxin that causes diarrhea and abdominal cramps. So why aren’t natives of high-risk countries affected in the same way? Often their bodies have become accustomed to the bacteria and developed immunity to them.

What is the risk factor?

Each year millions of international travelers experience traveler’s diarrhea. High-risk destinations for traveler’s diarrhea include many areas of Central and South America, Mexico, Africa, the Middle East and most of Asia. Traveling to Eastern Europe and a few Caribbean islands also poses some risk. However, your risk of traveler’s diarrhea is generally low in Northern and Western Europe, Japan, Canada, Australia, New Zealand and the United States. Your chances of getting traveler’s diarrhea are mostly determined by your destination. But certain groups of people have a greater risk of developing the condition. These include: ■

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Young adults. The condition is slightly more common in young adult tourists. Though the reasons why aren’t clear, it’s possible that young adults lack acquired immunity, they may be more adventurous in their travels and dietary choices, or they may be less vigilant in avoiding contaminated foods. People with weakened immune systems. A weakened immune system increases vulnerability to infections. People with diabetes or inflammatory bowel disease.These conditions can leave you more prone to infection. People who take acid blockers or antacids. Acid in the stomach tends to destroy organisms, so a reduction in stomach acid may leave more opportunity for bacterial survival. People who travel during certain seasons. The risk of traveler’s diarrhea varies by season in certain parts of the world. For example, risk is highest in South Asia during the hot months just before the monsoon.

What complications could you have? Because you lose vital fluids, salts and minerals during a bout with traveler’s diarrhea, you may become dehydrated. Dehydration is especially dangerous for children, older adults and people with weakened immune systems. Extreme fluid loss caused by diarrhea can cause serious complications, including organ damage, shock or coma. Signs and symptoms of dehydration include a very dry mouth, intense thirst, little or no urination, and extreme weakness.

Treatments and drugs Because traveler’s diarrhea tends to resolve itself, you may get better without any intervention. It’s important to try to stay hydrated with safe liquids, such as bottled water or canned juice. If you don’t seem to be improving quickly, you can turn to several medications to help relieve symptoms. ■

Anti-motility agents. These agents — which include loperamide (Imodium A-D) and drugs containing diphenoxylate (Lomotil, Lonox) — provide prompt but temporary relief by reducing muscle spasms in your gastrointestinal tract, slowing the transit time through your digestive system and allowing more time for absorption.Anti-motility medications aren’t recommended for infants or people with fever or bloody diarrhea, as they can delay clearance of the infectious organisms and make the illness worse.Also, stop using anti-motility agents after 48 hours if you have abdominal pain or your signs or symptoms worsen and your diarrhea continues. In such

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cases, see a doctor. Bismuth subsalicylate (Pepto-Bismol). This over-the-counter medication can decrease the frequency of your stools and shorten the duration of your illness. However, it isn’t recommended for children, pregnant women or people who are allergic to aspirin. Antibiotics. If you have more than four loose stools a day or severe symptoms, including fever or blood, pus or mucus in your stools, a doctor may prescribe a course of antibiotics.

Before you leave for your trip, talk to your doctor about appropriate medications to take with you so that you don’t have to buy diarrhea medications while traveling. Some of the drugs available in other countries may be unsafe. Some may even have been banned in the United States.

Avoiding dehydration Dehydration is the most likely complication of traveler’s diarrhea, so it’s important to try to stay well hydrated. An oral rehydration salts (ORS) solution is the best way to replace lost fluids. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. They also contain glucose to enhance absorption in the intestinal tract. Bottled oral rehydration products are available in drugstores in developed areas, and many pharmacies carry their own brands. You can find packets of powdered oral rehydration salts, labeled World Health Organization (WHO)-ORS, at stores, pharmacies and health agencies in most countries. Reconstitute the powder in bottled or boiled water according to the directions on the package. If these products are unavailable, you can prepare your own rehydrating solution in an emergency by mixing together: ■

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1/2 teaspoon salt 1/2 teaspoon baking soda 4 tablespoons sugar 1 liter safe drinking water

You or your child can drink the solution in small amounts throughout the day as a supplement to solid foods or formula, as long as dehydration persists. Small amounts reduce the likelihood of vomiting. Breast-fed infants also can drink the solution but should continue nursing on demand. If dehydration symptoms don’t improve, seek medical care right away. Oral rehydration solutions are intended only for urgent short-term use.

Lifestyle and home remedies If you do get traveler’s diarrhea, avoid caffeine and dairy products, which may worsen symptoms or increase fluid loss. But keep drinking fluids. Drink canned fruit juices, weak tea, clear soup, decaffeinated soda or sports drinks to replace lost fluids and minerals. Later, as your diarrhea improves, try a diet of easy-to-eat complex carbohydrates, such as salted crackers, bland cereals, bananas, applesauce, dry toast or bread, rice, potatoes, and plain noodles.

Once diarrhea goes away, you may return to your normal diet. Just be sure to add dairy products, caffeinated beverages and high-fiber foods cautiously.